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Imaging aortic root and aortic valve stenosis in percutaneous aortic valve implantation candidates
© Paelinck et al; licensee BioMed Central Ltd. 2010
Published: 21 January 2010
Percutaneous aortic valve implantation (PAVI) is an evolving interventional treatment modality. Aortic geometry, including aortic annulus size, is crucial for technical selection of PAVI (aortic root - prosthesis match). The role of non-invasive imaging techniques needs further validation.
We aimed to compare aortic valve area (AVA) and aortic root dimensions using catheterization and non-invasive imaging techniques.
In 38 consecutive high risk elderly (82 ± 6 years) symptomatic patients with severe aortic stenosis scheduled for potential PAVI, AVA was determined by direct planimetry (steady state free precession CMR and 3D echocardiography) and calculated by the Gorlin equation (cardiac catheterization) and continuity equation (Doppler).
Diameter of left ventricular outflow tract (LVOT), aortic annulus, sinus and sinotubular junction were measured using steady state free precession CMR, 2D echocardiography and invasive aortography. In addition, aortic annulus was measured using transoesophageal echocardiography.
Mean differences and 95% CI in AVA were 0.03 cm2 (0, 0.06) (p = NS) for catheterization versus Doppler echocardiography, 0.03 cm2 (-0.02, 0.08) (p = NS) for catheterization versus 3D echocardiography and 0.01 cm2 (-0.02, 0.05) (p = NS) for catheterization versus CMR.
LVOT and aortic root dimensions († P < 0.05)
mean difference and 95% CI (cm) 2D echocardiography versus
-0.02 (-0.1, 0.1)
0.42 (0.31, 0.52)†
-0.03 (-0.13, 0)†
0.06 (-0.06, 0.17)
-0.11 (-0.21, 0) †
0.01 (-0.08, 0.11)
-0.16 (-0.25, -0.08)†
-0.04 (-0.09, -0.01)
1. CMR planimetry, Doppler and 3D echocardiography provide an accurate estimate of AVA in comparison with catheterization.
2. Catheterization underestimates aortic annulus dimensions, while CMR overestimates aortic root dimensions in comparison with 2D echocardiography.
3. Transoesophageal echocardiography is crucial to assess aortic annulus requirements.
This article is published under license to BioMed Central Ltd.