Imaging in patients with severe mitral annular calcification: insights from a multicentre experience using transatrial balloon-expandable valve replacement
Autor: | Kyle W. Eudailey, Catherine Wang, Ashequl Islam, Deniz Akkoc, Torsten Vahl, Martin B. Leon, Omar K. Khalique, Alex Kantor, Joongheum Park, David W. Deaton, Rebecca T. Hahn, Raymond Lee, Tsuyoshi Kaneko, Mayra Guerrero, Ramesh Veeragandham, Michael A. Borger, Hyde M. Russell, Dee Dee Wang, Susheel Kodali, Isaac George, Fabien Praz, Isaac Y. Wu, Vinayak Bapat, Diana Leung, Hiroo Takayama, Tamim Nazif, Diane C H Tang |
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Rok vydání: | 2019 |
Předmět: |
Cardiac Catheterization
medicine.medical_specialty medicine.medical_treatment Population Heart Valve Diseases Diastole 030204 cardiovascular system & hematology Transcatheter Aortic Valve Replacement 03 medical and health sciences 0302 clinical medicine Valve replacement Aortic valve replacement Internal medicine medicine Humans Ventricular outflow tract Radiology Nuclear Medicine and imaging 030212 general & internal medicine Systole education Heart Valve Prosthesis Implantation education.field_of_study Mitral regurgitation business.industry valvular heart disease Aortic Valve Stenosis General Medicine medicine.disease Treatment Outcome Aortic Valve Heart Valve Prosthesis Cardiology Mitral Valve Cardiology and Cardiovascular Medicine business |
Zdroj: | European Heart Journal - Cardiovascular Imaging. 20:1395-1406 |
ISSN: | 2047-2412 2047-2404 |
Popis: | Aims To investigate valve sizing and the haemodynamic relevance of the predicted left ventricular outflow tract (LVOT) in patients with mitral annular calcification (MAC) undergoing transatrial transcatheter valve implantation (THV). Methods and results In total, 21 patients undergoing transatrial THV, multiplanar reconstruction (MPR), maximum intensity projection (MIP), and cubic spline interpolation (CSI) were compared for MA sizing during diastole. In addition, predicted neo-LVOT areas were measured in 18 patients and correlated with the post-procedural haemodynamic dimensions. The procedure was successful in all patients (100%). Concomitant aortic valve replacement was performed in eight patients (43%) (AVR group). Sizing using MPR and MIP yielded comparable results in terms of area, perimeter, and diameter, whereas the dimensions obtained with CSI were systematically smaller. The simulated mean systolic neo-LVOT area was 133.4 ± 64.2 mm2 with an anticipated relative LVOT area reduction (neo-LVOT area/LVOT area × 100) of 59.3 ± 14.7%. The systolic relative LVOT area reduction, but not the absolute neo-LVOT area, was found to predict the peak (r = 0.69; P = 0.002) and mean (r = 0.65; P = 0.004) post-operative aortic gradient in the overall population as well as separately in the AVR (peak: r = 0.91; P = 0.002/mean: r = 0.85; P = 0.002) and no-AVR (peak: r = 0.89; P = 0.003/mean: r = 0.72; P = 0.008) groups. Conclusion In patients with severe MAC undergoing transatrial transcatheter valve implantation, MPR, and MIP yielded comparable annular dimensions, while values obtained with CSI tended to be systematically smaller. Mitral annular area and the average annular diameter appear to be reliable parameters for valve selection. Simulated relative LVOT reduction was found to predict the post-procedural aortic gradients. |
Databáze: | OpenAIRE |
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