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European Radiology

, Volume 29, Issue 1, pp 259–269 | Cite as

Optimal pre-TAVR annulus sizing in patients with bicuspid aortic valve: area-derived perimeter by CT is the best-correlated measure with intraoperative sizing

  • Yuan Wang
  • Moyang Wang
  • Guanyuan Song
  • Wei Wang
  • Bin Lv
  • Hao Wang
  • Yongjian WuEmail author
Cardiac
  • 238 Downloads

Abstract

Objective

To clarify the optimal measurements for patients with bicuspid aortic valve (BAV) preferred for transcatheter aortic valve replacement (TAVR), our study compared intraoperative sizing with five different approaches by transthoracic echocardiography (TTE), three-dimensional transesophageal echocardiography (3DTEE) and computed tomography (CT).

Methods

We enrolled 104 BAV patients prescreened for TAVR but who underwent surgery with direct intraoperative annulus sizing. All five approaches [2DTTE, 3DTEE, area-derived perimeter (CTarea), perimeter-derived diameter (CTperi) and mean diameter (CTmean)] were compared with intraoperative sizing, respectively. Agreements on theoretical valve selections by five methods with those by intraoperative sizing were analyzed.

Results

CTarea showed the highest correlation (r = 0.932) and the best agreement with intraoperative sizing. Agreement for theoretical surgical and TAVR prosthesis selection was found in 84.6% and 74.0% BAVs by CTarea (κ = 0.791, κ = 0.585). CTperi-based prosthesis selection led to overestimation of 26.9% for surgical valves (κ = 0.589) and 36.5% for TAVR valves (κ = 0.425). Good correlations were observed between CT measurements and intraoperative sizing regardless of the predominant site of aortic valve calcification (r = 0.860-0.953).

Conclusion

The CTarea, which demonstrated the optimal approach to annulus sizing and prosthesis choice of BAVs with high eccentricity, should be included into the BAV-specific annulus sizing recommendation. The insufficiency of CTperi lay in overestimation of surgical or TAVR valve selections. Good agreement of 3DTEE sizing proved its superiority in annulus sizing for BAVs unsuitable for CT, but it should be used with caution for patients with a calcified annulus, where partial acoustic shadowing could lead to image inaccuracy.

Key Points

The area-derived perimeter by CT is the optimal approach to annulus sizing of BAVs.

The perimeter-derived approach is prone to overestimation of BAVs.

3DTEE showed its superiority in annulus sizing for BAVs unsuitable for CT, but it should be used with caution in patients with a calcified annulus.

Keywords

Aortic valve Transcatheter aortic valve replacement Echocardiography Multidetector computed tomography Aortic valve stenosis 

Abbreviations

BAV

Bicuspid aortic valve

BSA

Body surface area

TAV

Tricuspid aortic valve

TAVR

Transcatheter aortic valve replacement

Notes

Acknowledgements

The authors thank the staff members of the imaging department for their invaluable contribution.

Funding

This study was supported by grants from the Pecking Union Medical College Student Innovation Fund (project no. 2016-1002-01-05, Beijing, China) to YW.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Dr. Yongjian Wu.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• randomized controlled trial

• performed at one institution

Supplementary material

330_2018_5592_MOESM1_ESM.docx (20 kb)
ESM 1 (DOCX 20 kb)

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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Yuan Wang
    • 1
  • Moyang Wang
    • 1
  • Guanyuan Song
    • 1
  • Wei Wang
    • 2
  • Bin Lv
    • 3
  • Hao Wang
    • 4
  • Yongjian Wu
    • 1
    Email author
  1. 1.Department of Cardiology, Ward 52, Fuwai Hospital, National Center for Cardiovascular DiseaseChinese Academy of Medical Science and Peking Union Medical CollegeBeijingChina
  2. 2.Department of Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular DiseaseBeijingChina
  3. 3.Department of Radiology, Fuwai Hospital, National Center for Cardiovascular DiseaseBeijingChina
  4. 4.Department of Ultrasound, Fuwai Hospital, National Center for Cardiovascular DiseaseBeijingChina

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