Feasibility and Accuracy of 3DTEE Versus CT for the Evaluation of Aortic Valve Annulus to Left Main Ostium Distance Before Transcatheter Aortic Valve Implantation

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• 作者：Gloria Tamborini ; MD^鈦?/sup> ; ^{gloria.tamborini@ccfm.it} ; Laura Fusini ; MS^鈦?/sup> ; Paola Gripari ; MD^鈦?/sup> ; Manuela Muratori ; MD^鈦?/sup> ; Claudia Cefalù ; MD^鈦?/sup> ; Francesco Maffessanti ; PhD^鈦?/sup> ; Francesco Alamanni ; MD^鈦?/sup> ; ^&dagger ; ; Antonio Bartorelli ; MD^鈦?/sup> ; ^&dagger ; ; Gianluca Pontone ; MD^鈦?/sup> ; Daniele Andreini ; MD^鈦?/sup> ; Erika Bertella ; MD^鈦?/sup> ; Cesare Fiorentini ; MD^鈦?/sup> ; ^&dagger ; ; Mauro Pepi ; MD^鈦?/sup>
• 关键词：left main coronary artery occlusion ; 3-dimensional transesophageal echocardiography ; transcatheter aortic valve implantation
• 刊名：JACC ; Cardiovascular Imaging
• 出版年：2012
• 期刊代码：pca197_1936878X
• 类别：med
• 出版时间：June, 2012
• 卷：5
• 期：6
• 页码：579-588
• 文件大小：1580 K

摘要

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Objectives

The aims of this study were to analyze in a large series of patients undergoing transcatheter aortic valve implantation (TAVI): 1) the accuracy of 3-dimensional transesophageal echocardiographic (3DTEE) measurement of left coronary cusp (LCC) length and of the distances from left main coronary ostium (LM) to the aortic annulus (AA) pre-operatively and to the aortic prosthesis post-operatively; and 2) the role of the 3DTEE measurements in predicting the prosthetic deployment and the association between prosthesis position and aortic regurgitation (AR) and/or prosthesis-patient mismatch (PPM).

Background

Coronary ostia occlusion is a possible complication in TAVI; therefore, the careful pre-operative evaluation of AA-LM and LCC length, and the post-operative analysis of the relationship between the prosthesis and LM, may influence the procedural outcomes. Even though multidetector computed tomography (MDCT) is the gold standard pre-operatively, sometimes it cannot be performed and it is rarely repeated post-operatively.

Methods

In 122 patients undergoing TAVI, pre-operative AA-LM and LCC measurements obtained by 3DTEE and MDCT were compared. Post-operatively, the feasibility of 3DTEE evaluation of the prosthesis-LM distance was performed. The relationship between 3DTEE overlap of the prosthesis with the anterior mitral leaflet and AR/PPM was assessed.

Results

Pre-operatively, 3DTEE AA-LM (r = 0.83) and LCC (r = 0.69) significantly correlated with MDCT. Post-operatively, 3DTEE prosthesis-LM distance was 2.1 卤 1.9 mm. The prosthesis reached or exceeded LM in 6 and 10 cases, respectively. Prosthesis overlap with mitral leaflet was 4.7 卤 1.8 mm. Significant correlation between the 3DTEE computed and nominal length of the prosthesis was found (r = 0.61). No correlations were found between prosthesis-mitral leaflet overlap and aortic regurgitation or PPM.

Conclusions

AA-LM distance and LCC length may be accurately estimated by 3DTEE, which may represent a valid alternative to MDCT. Pre- and post-3DTEE data concerning the aortic root, such as LM, aortic valve, and prosthetic morphology, give new insights into TAVI and its complications.