Abstract Aims To compare the extent of cerebral ischemic injury after transcatheter aortic valve replacement (TAVR) with the use of an Embrella Embolic Deflector System versus unprotected TAVR. ...Methods Fifteen patients with severe symptomatic aortic stenosis underwent TAVR with use of the Embrella Embolic Deflector System for cerebral protection. Cerebral diffusion-weighted magnetic resonance imaging (DWI) was performed in all patients at day 4 after the procedure and images were retrospectively compared to 37 patients who had previously undergone TAVR without a protection device (TAVR-only group). Results Successful placement of the Embrella device was achieved in all patients. DWI revealed an increase in the number of ischemic lesions in the Embrella group compared with the TAVR-only group (9.0 vs 5.0, P = .044). The use of the Embrella device was however associated with a significant reduction in single-lesion volume: 9.7 μL 5.8, 18.4 versus 17.8 μL 9.5, 38.7 ( P < .001). Moreover, total infarct volumes of more than 1000 μL were only seen in the TAVR-only group. More lesions occurred in the right side of the brain in the Embrella group, whereas in the TAVR-only group lesions were distributed equally between left and right. One patient in the TAVR-only group suffered from a transient ischemic attack. Postoperative evaluation was clinically uneventful in the Embrella group. Conclusions The use of the Embrella device during TAVR increased the number of cerebral ischemic lesions on postprocedural brain imaging. This increase in number was however accompanied by a significant reduction in single-lesion volume and the absence of large total infarct volumes.
Aortic valve calcification correlates with the severity of aortic valve stenosis and a high calcium score is associated with conduction disturbances and paravalvular leakage after transcatheter ...aortic valve replacement. The 3mensio Structural Heart is a semiautomated software package to facilitate aortic root analysis by multislice computed tomography.
The aim of the contemporary study is to validate a semiautomated calcium quantification scoring tool with a conventional manual calcium quantification tool.
Fifty randomly selected patients who underwent multislice computed tomography for preprocedural planning were retrospectively selected to compare the semiautomated aortic valve Agatston calcium score by 3mensio with the manually obtained score using IntelliSpace Portal as standard reference.
Patients had a mean age of 76.7 ± 7.4 years and 60% were male. The median Agatston score was 3390 interquartile range 1877-4509 with 3mensio and 3434 interquartile range 1839-4620 with IntelliSpace.
The mean difference was -0.18 95% confidence interval (CI) −53.8 to 53.4. The intraclass correlation coefficient between the Agatston scores using IntelliSpace and 3mensio showed an excellent correlation of 0.995 95% CI 0.992-0.997, p ≤ 0.001. The interobserver and intraobserver variability was 0.993 (95% CI 0.961-0.998, p ≤ 0.001) and 0.995(95%CI 0.981-0.999, p = <0.001), respectively.
The semiautomated calcium quantification module in 3mensio Structural Heart highly correlated with a conventional manual calcium scoring tool.
•Aortic valve calcification is a predictor for aortic stenosis severity and for adverse outcomes after TAVR.•The semiautomated Agatston score module in 3mensio highly correlated with a conventional manual calcium scoring tool.•The semiautomated Agatston score module in 3mensio makes addition and quantification of the calcium distribution to the preprocedural planning accessible.
Highlights • With 4D flow, any plane of interest can be interactively chosen for quantitative measurements. • Anatomical and flow data is obtained during an approximately 10-minute free-breathing ...scan. • 4D CMR flow measurements correlated well with the 2D PC ones. • Eddy current correction is important for good results with 4D flow
The implanted prosthetic heart valve (PHV) size is vital for the evaluation of suspected PHV dysfunction and in case of reoperation or valve-in-valve transcatheter approaches. The labeled size is not ...always known, and discrepancies exist between manufacturers' labeled sizes and true sizes. Reproducible methods for noninvasive PHV size assessment are lacking. We determined the reliability and agreement of PHV size measurements using multidetector-row computed tomography (MDCT) and provide reference values of MDCT measurements compared with manufacturer specifications. In vitro, 15 different PHV types in available sizes (total n = 63) were imaged. In vivo, available MDCT acquisitions of patients with PHVs were retrospectively gathered in 2 centers, and 230 patients with 249 PHVs were included. Inner valve area and area-derived diameter were measured in all PHVs. For mechanical PHVs, the inner diameter was also measured. Data were analyzed using the intraclass correlation coefficient and Bland-Altman plots and related to manufacturer specifications. Measurements could be obtained for all PHV types, except the Björk-Shiley (n = 7) because of severe valve-related artifacts hampering the image quality. Intrarater and interrater reliability was excellent for biological and mechanical PHVs (intraclass correlation coefficients ≥0.903). Agreement was good for all measurements with an overall maximal mean difference (95% confidence interval) of −2.61 mm2 (−37.9 to 32.7), −0.1 mm (−1.1 to 1.0), and 0 mm (−0.4 to 0.3) for valve area, area-derived diameter, and inner diameter, respectively. MDCT reliably discriminated consecutive PHV sizes as labeled by the manufacturer because the absolute ranges for the measurements never overlapped. In conclusion, MDCT allows assessment of the implanted PHV size with excellent reliability and agreement and can discriminate between PHV sizes for contemporary prostheses. MDCT can be used to noninvasively identify the manufacturer-labeled PHV size.
For evaluation of prosthetic heart valve obstruction echocardiography and fluoroscopy provide primarily functional information but may not unequivocally establish the cause of dysfunction. Our ...objective was to evaluate whether multidetector-row computed tomographic (MDCT) imaging could detect the morphologic substrate for such functional abnormalities. Thirteen patients with 15 prosthetic valves, in whom prosthetic valve obstruction was suspected from echocardiography or fluoroscopy but no sufficient cause could be found, underwent electrocardiographically gated multidetector-row computed tomography. MDCT data were retrospectively reconstructed at every 10% of the electrocardiographic interval and analyzed using multiplanar reformatting in anatomically adapted planes. MDCT images were evaluated for morphologic prosthetic and periprosthetic abnormalities. Results could be compared to intraoperative findings or autopsy in 7 patients. Multidetector-row computed tomography disclosed a morphologic substrate for obstruction in 8 of 13 patients. MDCT findings compatible with obstruction were confirmed at surgery or autopsy in 6 patients. In a seventh patient, incomplete leaflet closure found with multidetector-row computed tomography was confirmed at surgery. The most commonly identified causes for obstruction were subprosthetic tissue (6 patients) and abnormal anatomic orientation (3 patients). Despite an indication for surgery, 2 patients were not operated on due to recurrent bacteremias and prohibitive co-morbidity. Multidetector-row computed tomography detected leaflet motion restriction in 7 patients compared to 4 by fluoroscopy. Confirmation of leaflet restriction was available in 5 patients. Multidetector-row computed tomography missed a periprosthetic leak. In conclusion, this initial experience demonstrates that multidetector-row computed tomography can identify causes of prosthetic valve obstruction that constitute indications for surgery but are missed at echocardiography or fluoroscopy.
Knowledge of the dynamic changes of the aortic valve (AV) annulus may aid in the sizing and design of transcatheter valve prostheses. We assessed AV annulus distention in patients without AV disease ...and with severe AV stenosis (AS) using computed tomography (CT).
Electrocardiogram-gated multislice CT scans of 15 patients without AV disease (age 53±12 years) and 20 patients with severe AS (age 81±6 years) were analyzed. Images in plane with the AV annulus were reconstructed for every 10% to 12.5% of the cardiac cycle. With the use of dedicated software the annulus was segmented. In all phases of the cardiac cycle the area was measured, as were the maximum radius (Rmax) and minimum radius (Rmin) of an ellipse fitted around the segmented lumen. The asymmetry ratio was defined as Rmax/Rmin. Direct comparison of both groups was not possible because age and scan protocols were confounding factors.
The mean change of the area, Rmax, and Rmin was 122±33 mm2, 1.8±0.7 mm, and 2.4±0.5 mm in the patients with nondiseased annulus and 98±52 mm2, 1.4±0.7 mm, and 1.9±0.8 mm in those with AS. The mean asymmetry ratio was 1.3±0.1, indicating an elliptic annulus. Both the asymmetry ratio and the area changed significantly over the cardiac cycle (p<0.001).
With the use of CT and postprocessing software, significant area and radius changes during the cardiac cycle were demonstrated in both the nondiseased annulus and the stenotic annulus. This finding may help selection of the optimal size in patients undergoing AV implantation and also aid in prosthesis design.
Abstract Objective To evaluate the effect of chest size on coronary calcium score (CCS) as assessed with new-generation CT systems from 4 major vendors. Methods An anthropomorphic, small-sized (300 × ...200 mm) chest phantom containing 100 small calcifications (diameters, 0.5–2.0 mm) was evaluated with and without an extension ring on state-of-the-art CT systems from 4 vendors. The extension ring was used to mimic a patient with a large chest size (400 × 300 mm). Image acquisition was repeated 5 times with small translations and/or rotations. Routine clinical acquisition and reconstruction protocols for small and large patients were used. CCS was quantified as Agatston and mass scores with vendor software. Results The small-sized phantom resulted in median (interquartiles) Agatston scores of 10 (9–35), 136 (123–146), 34 (30–37), and 87 (85–89) for Philips, GE, Siemens, and Toshiba, respectively. Mass scores were 4 mg (3–9 mg), 23 mg (21–27 mg), 8 mg (8–9 mg), and 20 mg (20–20 mg), respectively. Adding the extension ring resulted in reduced Agatston scores for all vendors (17%–48%) and mass scores for 2 vendors (11%–49%). Median Agatston scores decreased to 9 (5–10), 79 (60–80), 27 (24–32), and 45 (29–53) units, and median mass scores remained similar for Philips at 4 mg (4–6 mg) and Siemens at 8 mg (7–8 mg) and decreased for the other vendors to 13 mg (11–14 mg) and 10 mg (8–13 mg), respectively. Conclusion This multivendor phantom study showed that CCS can be underestimated up to 50% (49%–66%) for Agatston scores and 49% (36%–59%) for mass scores at a larger chest size, which may be relevant for women and large patients. However, CCS underestimation by chest size differs considerably by vendor.
Tissue-engineered heart valves (TEHV) are being explored as an alternative to conventional heart valve prostheses. Using the classic tissue engineering paradigm, a stented tri-leaflet valve is ...fabricated. Subsequently, the construct is implanted into the pulmonary position in a sheep. Follow-up by means of computed tomography, magnetic resonance imaging, and echocardiography was used to assess tissue formation. After 4 weeks, the scaffold of the TEHV has degraded and new tissue is formed. However, small areas without tissue formation were present at macroscopic inspection. This phenomenon was only visible on computed tomographic images. Therefore, computed tomography appears a promising technique for in vivo follow-up of tissue formation in tissue-engineered heart valves.
...FDG-PET imaging is a promising and welcome new imaging tool for PHV endocarditis. ...specificity is a concern because normal FDG uptake around PHVs, in particular early after operation, is not ...known. ...the proposed addition of PET/CT to the Duke criteria as a major criterion is to our opinion too premature.
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