Hemodynamics of a stenosed aortic valve: Effects of the geometry of the sinuses and the positions of the coronary ostia

Anatomic landmark detection is crucial during preoperative planning of transcatheter aortic valve implantation (TAVI) to select the proper device size and assess the risk of complications. The detection is currently a time-consuming manual process influenced by the image quality and subject to operator variability. In this work, we propose a novel automatic method to detect the relevant aortic landmarks from MDCT images using deep learning techniques. We trained three convolutional neural networks (CNNs) with 344 multidetector computed tomography (MDCT) acquisitions to detect five anatomical landmarks relevant for TAVI planning: the three basal attachment points of the aortic valve leaflets and the left and right coronary ostia. The detection strategy used these three CNN models to analyse a single MDCT image and yield three segmentation volumes as output. These segmentation volumes were averaged into one final segmentation volume, and the final predicted landmarks were obtained during a postprocessing step. Finally, we constructed the aortic annular plane, defined by the three predicted hinge points, and measured the distances from this plane to the predicted coronary ostia (i.e., coronary height). The methodology was validated on 100 patients. The automatic landmark detection was able to detect all the landmarks and showed high accuracy as the median distance between the ground truth and predictions is lower than the interobserver variations (1.5 mm [1.1–2.1], 2.0 mm [1.3–2.8] with a paired difference −0.5 ± 1.3 mm and p value <0.001). Furthermore, a high correlation is observed between predicted and manually measured coronary heights (for both R2 = 0.8). The image analysis time per patient was below one second. The proposed method is accurate, fast, and reproducible. Embedding this tool based on deep learning in the preoperative planning routine may have an impact in the TAVI environments by reducing the time and cost and improving accuracy.

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Replacement of the Ascending Aorta and Aortic Valve with a Composite Graft in Patients with Nondisplaced Coronary Ostia

The Annals of Thoracic Surgery ◽

10.1016/s0003-4975(10)63239-0 ◽

1982 ◽

Vol 33 (4) ◽

pp. 406-409 ◽

Cited By ~ 67

Author(s):

Jeffrey M. Piehler ◽

James R. Pluth

Keyword(s):

Aortic Valve ◽

Composite Graft ◽

Ascending Aorta ◽

Coronary Ostia

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Computed tomography analysis of coronary ostia location following valve‐in‐valve transcatheter aortic valve replacement with the ACURATE neo valve: Implications for coronary access

Catheterization and Cardiovascular Interventions ◽

10.1002/ccd.29503 ◽

2021 ◽

Author(s):

Arif A. Khokhar ◽

Alessandra Laricchia ◽

Francesco Ponticelli ◽

Won‐Keun Kim ◽

Francesco Gallo ◽

...

Keyword(s):

Computed Tomography ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Transcatheter Aortic Valve ◽

Valve In Valve ◽

Coronary Ostia ◽

Tomography Analysis

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P218 Accuracy and reproducibility of aortic root assessment by eSie Valves in patients candidate to transcatheter aortic valve implantation: a comparative study with computed tomography

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.084 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

G Granata ◽

A Veltri ◽

S Iuliano ◽

V Romano ◽

S Stella ◽

...

Keyword(s):

Computed Tomography ◽

Coronary Artery ◽

Aortic Valve ◽

Transcatheter Aortic Valve Implantation ◽

Aortic Root ◽

3D Model ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Coronary Ostia ◽

Valve Implantation

Abstract Background Accurate imaging assessment of the aortic root (AR) is critical for prosthesis sizing in transcatheter aortic valve implantation. Multislice computed tomography (MSCT) is the gold standard for this purpose. 3D transesophageal (3D-TOE) reconstruction tools have recently been introduced, which automatically configures a geometric model of AR from 3D-TOE dataset and perform quantitative analyses of the AR. Purpose The aim of the study was to compare semi-automated measurements of AR obtained by eSie Valves (EV) (Siemens Medical Solution, California, USA) tool with MSCT. Methods We prospectively enrolled 26 consecutive patients (mean age 79.5 ± 7.5 years; 38% men) with severe symptomatic aortic stenosis (mean gradient 48.8± 13.6 mmHg) who underwent both 3D-TOE and MSCT as part of TAVI evaluation protocol. Volumetric datasets of the AR, acquired with 3D-TOE in mid-esophageal view, were analyzed with EV tool. EV tool automatically detected AR landmarks and, after user validation, created 3D model of AR providing values of area, perimeter, diameters of aortic annulus (AA) and coronary ostia heights (Fig 1). Results EV tool analysis on 3D-TOE volumetric data sets was feasible in all patients. Strong correlation between EV tool and MSCT assessment for AA major diameter (r = 0.79), AA minor diameter (r = 0.81), AA perimeter (r = 0.89) and AA area (r = 0.89) (all p< 0.0001) was found. On average EV tool underestimated MSCT measurements of AA major diameter (1.2 mm, 4.5%), AA minor diameter (2.6 mm, 11.3%), AA perimeter (4 mm, 5.2%) and AA area (65.3 mmq, 13.6%). Moderate correlation between the two methods, already in this initial sample, for right coronary artery ostium height (r = 0.53, p = 0.007) was discovered. Finally, weak correlation for left coronary artery ostium height (r = 0.33, p = 0.1) was revealed. EV tool measurements from two different volumetric datasets of the same patient showed an excellent reproducibility intraclass correlation coefficient (ICC) for AA area 0.94 and ICC for right coronary height 0.98. Conclusion With these initial results EV tool could be used in clinical practice for quick and reliable assessment of AA area, perimeter and diameters. A larger group of patients will be needed to assess the consistency of coronary ostia height evaluation by EV tool. Abstract P218 Figure. eSie Valve landmarks and 3D model of AR

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Calcified Embolus of the Left Coronary Ostia After Aortic Valve Replacement

The Annals of Thoracic Surgery ◽

10.1016/s0003-4975(97)00192-6 ◽

1997 ◽

Vol 63 (4) ◽

pp. 1162-1163 ◽

Cited By ~ 4

Author(s):

Thierry A Folliguet ◽

Marie-Christine Malergue ◽

Jacques Temkine ◽

Alain Dibie ◽

Jean Petrie ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Coronary Ostia

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Fluid Study of Transcatheter Aortic Valve Deployment Into Patients With Varying Coronary Ostia Position

ASME 2011 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2011-53891 ◽

2011 ◽

Author(s):

Eric Sirois ◽

Qian Wang ◽

Susheel Kodali ◽

Wei Sun

Keyword(s):

Aortic Valve ◽

Aortic Root ◽

Cfd Simulation ◽

Patient Specific ◽

Coronary Ostium ◽

Case Scenario ◽

Element Analysis ◽

Worst Case ◽

Transcatheter Aortic Valve ◽

Coronary Ostia

Recently, minimally-invasive transcatheter aortic valve (TAV) replacement has emerged as a viable alternative to traditional open-chest heart valve replacement for high risk patients who otherwise have limited or no treatment options. Although significant experience with TAV procedures has been gained, various adverse effects have been observed after device implantation [1, 2]. One adverse event is the impairment of coronary artery flow. Because the TAV stent pushes the native leaflets towards the sinus of Valsalva during TAV deployment, the flow boundaries in the aortic root are consequently altered. A worst case scenario would be the occlusion of the coronary ostia. Reduced flow to the coronary arteries has also been observed for some patients following TAV intervention [3]. With IRB approval, we recently conducted a dimensional analysis of 3D aortic root geometries, reconstructed from 64-slice CT scans of 95 patients [4]. TAV-relevant dimensions were measured. The spatial distribution of the left coronary ostium was quantified (Fig. 1). In this study, we will construct a patient-specific aortic root model with varied coronary ostium locations as shown in Fig. 1, and perform a combined finite element analysis (FEA) and computational fluid dynamics (CFD) simulation to investigate hemodynamic environment changes that occur following TAV intervention.

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Self-navigated MRI 3D whole heart sequence for non-enhanced aortic root measurement in transcatheter aortic valve intervention: comparison to cardiac CT

European Heart Journal ◽

10.1093/ehjci/ehaa946.0304 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M Holzknecht ◽

M Pamminger ◽

C Tiller ◽

C Kranewitter ◽

C Kremser ◽

...

Keyword(s):

Image Quality ◽

Aortic Valve ◽

Lower Limit ◽

Aortic Root ◽

Kappa Statistics ◽

Transcatheter Aortic Valve ◽

Upper Limit ◽

Significant Difference ◽

Coronary Ostia ◽

Whole Heart

Abstract Purpose To evaluate image quality, inter-observer reliability and diagnostic accuracy of self-navigated noncontrast 3D whole-heart magnetic resonance angiography (MRA) for transcatheter aortic valve intervention (TAVI) evaluation in comparison to standardized contrast-enhanced computed tomography angiography (CTA). Methods Whole-heart 1.5 T MRA was performed in 33 patients (aged 84 years [IQR 79–86], 48% male) for aortic root sizing and measurements of coronary ostia heights. A subgroup of 18 (55%) patients underwent additional CTA as gold standard for TAVI measurements. Image quality was assessed by a 4-point Likert scale, continuous MRA and CTA measurements were compared with regression and Bland-Altman analysis, valve sizing by kappa statistics. Results Median image quality of MRA as rated by two observers according was 1.5 [IQR 1.5–2.5]. In 4 patients (12%) one coronary ostium each (right coronary artery 3, left main artery 1) was not clearly definable on MRA. Inter-observer correlation was substantial to excellent (r=0.61 to 0.92) with a bias of 19 mm2 for annulus area (lower limit of agreement −59 mm2, upper limit of agreement 98 mm2; p=0.009). Aortic root and ostia height measurements by MRA and CTA showed substantial to excellent correlation (r=0.65 to 0.90) with no significant bias (all p≥0.333). Mean annulus area for MRA was 414±71 mm2 and for CTA 422±80 mm2 (r=0.9) with a bias of −8 mm2 (lower limit of agreement −79 mm2, upper limit of agreement −62 mm2; p=0.333). Regarding prosthetic valve sizing there was complete consistency between MRA and CTA-based decisions (κ=1). Conclusion Self-navigated noncontrast 3D whole-heart MRA enables reliable aortic root TAVI measurements without significant difference to standardized CTA. Prosthesis sizing by MRA measurements would completely match to CTA-based choice. However, in some cases coronary ostia may be difficult to define. Funding Acknowledgement Type of funding source: None

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Rescue Surgery 19 Years after Composite Root and Hemiarch Replacement

Case Reports in Surgery ◽

10.1155/2013/619282 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Konstantin von Aspern ◽

Joerg Seeburger ◽

Christian D. Etz ◽

Matthias Sauer ◽

Lukas Lehmkuhl ◽

...

Keyword(s):

Computed Tomography ◽

Chest Pain ◽

Aortic Valve ◽

Aortic Dissection ◽

Acute Chest Pain ◽

Type A Aortic Dissection ◽

Coronary Ostia ◽

Aortic Anastomosis ◽

Hemiarch Replacement ◽

Complex Surgery

A 59-year-old male patient with Marfan's syndrome was referred to our clinic due to acute chest pain. His medical history contains complex surgery for type A aortic dissection 19 years ago including composite root replacement using a mechanical aortic valve. Immediate computed tomography indicated perforation at the distal ascending aortic anastomosis plus complete avulsion of both coronary ostia. The patient underwent successful rescue surgery with ascending aortic and arch replacement using a modified Cabrol technique.

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