This study sought to examine a possible relationship between the severity of aortic valve calcification (AVC), the distribution of AVC and the degree of aortic valve regurgitation (AR) after transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS).
57 patients (22 men, 81 ± 5 years) with symptomatic AS and with a logistic EuroSCORE of 24 ± 12 were included. 38 patients (67%) received a third (18F)-generation CoreValve® aortic valve prosthesis, in 19 patients (33%) an Edwards SAPIEN™ prosthesis was implanted. Prior to TAVI dual-source computed tomography for assessment of AVC was performed. To determine the distribution of AVC the percentage of the calcium load of the most severely calcified cusp was calculated. After TAVI the degree of AR was determined by angiography and echocardiography. The severity of AR after TAVI was related to the severity and distribution of AVC.
There was no association between the distribution of AVC and the degree of paravalvular AR after TAVI as assessed by angiography (r = -0.02, p = 0.88). Agatston AVC scores were significantly higher in patients with AR grade ≥ 3 (5055 ± 1753, n = 3) than in patients with AR grade < 3 (1723 ± 967, p = 0.03, n = 54). Agatston AVC scores > 3000 were associated with a relevant paravalvular AR and showed a trend for increased need for second manoeuvres. There was a significant correlation between the severity of AVC and the degree of AR after AVR (r = 0.50, p < 0.001).
Patients with severe AVC have an increased risk for a relevant AR after TAVI as well as a trend for increased need for additional procedures.
"Moreover, AVC is a powerful predictor of adverse clinical events for patients with cardiac (Pohle et al., 2001; Palmiero et al., 2007; Corciu et al., 2010; Pradelli et al., 2013) and vascular diseases (Rossi et al., 2013), and in the general population (Rosenhek et al., 2000, 2004; Pohle et al., 2001; Branch et al., 2002; Nemcsik et al., 2007; Palmiero et al., 2007; Ishii et al., 2009; Corciu et al., 2010). AVC has also been recognized as a risk factor for complications after transcatheter aortic valve implantations (Colli et al., 2011; Koos et al., 2011). Bicuspid aortic valve (BAV) is a congenital malformation especially prone to "
[Show abstract][Hide abstract] ABSTRACT: IntroductionAortic valve calcification (AVC) may predict poor outcome. Bicuspid aortic valve (BAV) leads to several haemodynamic changes accelerating the progress of aortic valve (AV) disease.AimsTo compare the diagnostic accuracy of transoesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) in the assessment of aortic valve phenotype and degree of AVC, with intra-operative evaluation as a reference.Methods
We examined 169 patients (median age 65 years, 51 women) without significant coronary artery disease undergoing AV and/or aortic root surgery. TTE was performed within a week prior to surgery and TEE at the time of surgery.ResultsCompared with surgical AVC assessment, visual evaluation using a 5-grade scoring system and real-time images showed a higher correlation (TTE r = 0·83 and TEE r = 0·82) than visual (TTE r = 0·64 and TEE 0·63) or grey scale mean (GSMn) (TTE r = 0·63 and TEE r = 0·52) assessment of end-diastolic still frames. AVC assessment using real-time images showed high intraclass correlation coefficients (TTE 0·94 and TEE 0·93). With regard to BAV, TEE was superior to TTE with a higher interobserver agreement, sensitivity and specificity (0·86, 92% and 94% versus 0·57, 77% and 82%, respectively).Conclusion
Semi-quantitative AVC assessment of real-time cine loops from both TEE and TTE correlated well with intra-operative evaluation of AVC. Applying a predefined scoring system for AVC evaluation assures a high interobserver correlation. TEE was superior to TTE for evaluation of valve phenotype and should be considered when a diagnosis of BAV is clinically important.
"AVC can be assessed in the cross-sectional view of the sinus of Valsalva (SOV) either qualitatively (mild, moderate, severe) or quantitatively using Agatston units (Agatston Score), the calcified volume score (in mm3) or mass score (in mg of CAHA), similar to the assessment of coronary calcifications [38, 43]. Agatston scores exceeding 3,000 are correlated with an increased incidence of paravalvular regurgitation after TAVR . Semiquantitative scores assess the number of affected cusps, homogeneous versus more focal distribution of calcium and involvement of coronary versus non-coronary cusps. "
[Show abstract][Hide abstract] ABSTRACT: Transcatheter aortic valve replacement (TAVR) is a novel technique developed in the last decade to treat severe aortic stenosis in patients who are non-surgical candidates because of multiple comorbidities.
Since the technique is performed using a transvascular approach, pre-procedural assessment of the aortic valve apparatus, ascending aorta and vascular access is of paramount importance for both appropriate patient selection and correct device selection. This assessment is performed by a multi-disciplinary team with radiology being an integral and important part.
Among imaging modalities, there is growing scientific evidence supporting the crucial role of MDCT in the assessment of the aortic valve apparatus, suitability of the iliofemoral or alternative pathway, and determination of appropriate coaxial angles. MDCT also plays an important role in post-procedure imaging in the assessment of valve integrity and position.
This review outlines the principal aspects of TAVR, the multidisciplinary approach and utilisation of different imaging modalities, as well as a step-by-step approach to MDCT acquisition protocols, reconstruction techniques, pre-procedure measurements and post-procedure assessment.
• TAVR is a new technique to treat severe aortic stenosis in high-risk and nonsurgical candidates. • MDCT assessment of the aortic annulus is important for appropriate patient and device selection. • Multidisciplinary approach is required for patient selection, procedure planning and performance. • MDCT is required for assessment of the aortic root, iliofemoral or alternative vascular pathway.
Insights into Imaging 01/2014; 5(1). DOI:10.1007/s13244-013-0301-5
"Nonenhanced CT can provide supplementary calcium scoring. Koos et al. reported significant association between total valvular calcium load and relevant PAR in 59 patients (they defined a threshold of 3000 Agatston score) . Likewise, Haensig et al. found higher valvular calcification in patients with mild and moderate regurgitation compared to those without PAR . "
[Show abstract][Hide abstract] ABSTRACT: This paper describes "how to" examine cardiac valves with computed tomography, the normal, diseased valves, and prosthetic valves. A review of current scientific literature is provided. Firstly, technical basics, "how to" perform and optimize a multislice CT scan and "how to" interpret valves on CT images are outlined. Then, diagnostic imaging of the entire spectrum of specific valvular disease by CT, including prosthetic heart valves, is highlighted. The last part gives a guide "how to" use CT for planning of transcatheter aortic valve implantation (TAVI), an emerging effective treatment option for patients with severe aortic stenosis. A special focus is placed on clinical applications of cardiac CT in the context of valvular disease.
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