A prototype self-navigated MRI 3D ‘whole heart’ sequence for non-enhanced aortic root measurement in transcatheter aortic valve intervention: comparison to cadiac CT

2020 ◽  
Author(s):  
M Pamminger ◽  
C Kranewitter ◽  
C Kremser ◽  
B Henninger ◽  
G Reiter ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Root ◽  
Transcatheter Aortic Valve ◽  
Root Measurement ◽  
Whole Heart

Self-navigated versus navigator-gated 3D MRI sequence for non-enhanced aortic root measurement in transcatheter aortic valve implantation

2021 ◽  
Vol 137 ◽  
pp. 109573
Author(s):  
Mathias Pamminger ◽  
Christof Kranewitter ◽  
Christian Kremser ◽  
Martin Reindl ◽  
Sebastian J. Reinstadler ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Aortic Root ◽  
3D Mri ◽  
Transcatheter Aortic Valve ◽  
Root Measurement ◽  
Aortic Valve Implantation ◽  
Valve Implantation

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

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

scholarly journals Effect of Eccentric Calcification of an Aortic Valve on the Implant Depth of a Venus-A Prosthesis During Transcatheter Aortic Valve Replacement: A Retrospective Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Lanlan Li ◽  
Yang Liu ◽  
Ping Jin ◽  
Jiayou Tang ◽  
Linhe Lu ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Aortic Root ◽  
Transcatheter Aortic Valve Replacement ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Release Process ◽  
Standard Position ◽  
Transcatheter Aortic Valve

ObjectOur goal was to assess the implant depth of a Venus-A prosthesis during transcatheter aortic valve replacement (TAVR) when the areas of eccentric calcification were distributed in different sections of the aortic valve.MethodsA total of 53 patients with eccentric calcification of the aortic valve who underwent TAVR with a Venus-A prosthesis from January 2018 to November 2019 were retrospectively analyzed. The patients were divided into three groups (A, B, and C) according to the location of the eccentric calcification, which was determined by preprocedural computerized tomography angiography (CTA) images. The prosthesis release process and position were evaluated by contrast aortography during TAVR, and the differences in valve implant depths were compared among the three groups. The effects of different aortic root structures and procedural strategies on prosthesis implant depth were analyzed.ResultsEleven patients had eccentric calcification in region A; 19 patients, in region B; and 23 patients, in region C. The patients with eccentric calcification in region B had a higher risk of prosthesis migration (10.5% upward and 21.1% downward), and the position of the prosthesis after TAVR in group B was the deepest among the three groups. When eccentric calcification was located in region A or C, the prosthesis was released at the standard position with more stability, and the location of the prosthesis was less deep after TAVR (region A: 4.12 ± 3.4 mm; region B: 10.2 ± 5.3 mm; region C: 8.4 ± 4.0 mm; region A vs. region B, P = 0.0004; region C vs. region B; and P = 0.0360). In addition, the left ventricular outflow tract (LVOT) (P = 0.0213) and aortic root angulation (P = 0.0263) also had a significant effect on implant depth in the aortic root structure of the patients. The prosthesis size was 28.3 ± 2.4 in the deep implant group and 26.4 ± 2.0 in the appropriate implant group (P = 0.0068).ConclusionThe implant depth of the Venus-A prosthesis is closely related to the distribution of eccentric calcification in the aortic valve during TAVR. Surgeons should adjust the surgical strategy according to aortic root morphology to prevent prosthesis migration.

scholarly journals Numerical Parametric Study of Paravalvular Leak Following a Transcatheter Aortic Valve Deployment Into a Patient-Specific Aortic Root

2018 ◽  
Vol 140 (10) ◽  
Author(s):  
Wenbin Mao ◽  
Qian Wang ◽  
Susheel Kodali ◽  
Wei Sun
Keyword(s):  
Aortic Valve ◽  
Computational Model ◽  
Aortic Root ◽  
Paravalvular Leak ◽  
Patient Specific ◽  
Fe Method ◽  
Transcatheter Aortic Valve ◽  
Operative Planning ◽  
The Difference ◽  
The Impact

Paravalvular leak (PVL) is a relatively frequent complication after transcatheter aortic valve replacement (TAVR) with increased mortality. Currently, there is no effective method to pre-operatively predict and prevent PVL. In this study, we developed a computational model to predict the severity of PVL after TAVR. Nonlinear finite element (FE) method was used to simulate a self-expandable CoreValve deployment into a patient-specific aortic root, specified with human material properties of aortic tissues. Subsequently, computational fluid dynamics (CFD) simulations were performed using the post-TAVR geometries from the FE simulation, and a parametric investigation of the impact of the transcatheter aortic valve (TAV) skirt shape, TAV orientation, and deployment height on PVL was conducted. The predicted PVL was in good agreement with the echocardiography data. Due to the scallop shape of CoreValve skirt, the difference of PVL due to TAV orientation can be as large as 40%. Although the stent thickness is small compared to the aortic annulus size, we found that inappropriate modeling of it can lead to an underestimation of PVL up to 10 ml/beat. Moreover, the deployment height could significantly alter the extent and the distribution of regurgitant jets, which results in a change of leaking volume up to 70%. Further investigation in a large cohort of patients is warranted to verify the accuracy of our model. This study demonstrated that a rigorously developed patient-specific computational model can provide useful insights into underlying mechanisms causing PVL and potentially assist in pre-operative planning for TAVR to minimize PVL.

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