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Five-Year Outcomes for Patients With RVOT Dysfunction Treated With the SAPIEN 3 Transcatheter Heart Valve: A Pooled Analysis From the COMPASSION S3 Trial.

Circulation. Cardiovascular interventions·2026

Related Experiment Video

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Four-Dimensional Computed Tomography-Guided Valve Sizing for Transcatheter Pulmonary Valve Replacement
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Computed tomography guided sizing for transcatheter pulmonary valve replacement.

Lara Curran1, Harsh Agrawal1, Kimberly Kallianos2

  • 1Department of Cardiology, University of California, San Francisco, United States.

International Journal of Cardiology. Heart & Vasculature
|September 5, 2020
PubMed
Summary

Computed Tomography Angiography (CTA) measurements accurately predict prosthetic valve size for transcatheter pulmonary valve replacement (TPVR). These CT-derived measurements are highly effective, especially when excluding patients with right ventricular outflow tract (RVOT) conduits.

Keywords:
Darea, Area-derived DiameterDcirc, Circumference-derived DiameterRVOT, Right Ventricular OutflowTAVR, Transcatheter Aortic Valve ReplacementTPVR, Transcatheter Pulmonary Valve Replacement

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Area of Science:

  • Cardiology
  • Radiology
  • Medical Imaging

Background:

  • Transcatheter pulmonary valve replacement (TPVR) is an alternative to surgery for right ventricular outflow tract (RVOT) dysfunction.
  • Accurate valve sizing is crucial for successful TPVR outcomes.
  • CT imaging offers a non-invasive method to assess RVOT dimensions.

Purpose of the Study:

  • To evaluate the predictive value of Computed Tomography Angiography (CTA) measurements of the RVOT for transcatheter valve sizing.
  • To determine if CT imaging can accurately predict the required implant size for TPVR.
  • To compare the accuracy of different CT measurement methods (circumference-derived and area-derived diameters).

Main Methods:

  • Retrospective analysis of 18 patients undergoing catheterization for potential TPVR.
  • CT measurements of the RVOT (Dcirc and Darea) were obtained.
  • Predicted valve size was generated using manufacturer guidelines and compared to the implanted valve size.
  • Inter-rater agreement was assessed using Cohen's kappa coefficient.

Main Results:

  • Both Darea (κ = 0.697) and Dcirc (κ = 0.540) measurements were good predictors of implanted valve size.
  • Excluding patients with RVOT conduits significantly improved predictive accuracy for both Darea (κ = 0.882) and Dcirc (κ = 0.882).
  • The study included patients with diagnoses such as Tetralogy of Fallot, d-Transposition repair, congenital pulmonary stenosis, and carcinoid heart disease.

Conclusions:

  • CT measurements of the RVOT (Darea or Dcirc) are valuable tools for predicting prosthetic valve sizing in TPVR.
  • These CT-derived measurements demonstrate good predictive accuracy.
  • The predictive value of CT measurements is reduced in patients with RVOT conduits compared to those with native RVOT or pulmonic bioprostheses.