多层螺旋计算机断层扫描对主动脉根部的无创评估及其在经导管主动脉瓣置换术中的意义

Noninvasive evaluation of the aortic root with multislice computed tomography implications for transcatheter aortic valve replacement.

作者信息

Tops Laurens F, Wood David A, Delgado Victoria, Schuijf Joanne D, Mayo John R, Pasupati Sanjeevan, Lamers Frouke P L, van der Wall Ernst E, Schalij Martin J, Webb John G, Bax Jeroen J

机构信息

Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Leiden, the Netherlands.

出版信息

JACC Cardiovasc Imaging. 2008 May;1(3):321-30. doi: 10.1016/j.jcmg.2007.12.006.

DOI:10.1016/j.jcmg.2007.12.006

PMID:19356444

Abstract

OBJECTIVES

In the present study, the anatomy of the aortic root was assessed noninvasively with multislice computed tomography (MSCT).

BACKGROUND

Transcatheter aortic valve replacement has been proposed as an alternative to surgery in high-risk patients with severe aortic stenosis. For this procedure, detailed knowledge of aortic annulus diameters and the relation between the annulus and the coronary arteries is needed.

METHODS

In 169 patients (111 men, age 54 +/- 11 years), a 64-slice MSCT scan was performed for evaluation of coronary artery disease. Of these, 150 patients had no or mild aortic stenosis, and 19 patients had moderate to severe aortic stenosis. Reconstructed coronal and sagittal views were used for assessment of the aortic annulus diameter in 2 directions. In addition, the distance between the annulus and the ostium of the right and left coronary arteries and the length of the coronary leaflets were assessed. The LV outflow tract and interventricular septum were analyzed on the single oblique sagittal view at end-diastole.

RESULTS

The diameter of the aortic annulus was 26.3 +/- 2.8 mm on the coronal view, and 23.5 +/- 2.7 mm on the sagittal view. Mean difference between the 2 diameters was 2.9 +/- 1.8 mm, indicating an oval shape of the aortic annulus. Mean distance between the aortic annulus and the ostium of the right coronary artery was 17.2 +/- 3.3 mm, and mean distance between the annulus and the ostium of the left coronary artery was 14.4 +/- 2.9 mm. In 82 patients (49%), the length of the left coronary leaflet exceeded the distance between the annulus and the ostium of the left coronary artery. There were no significant differences in the diameter of annulus, diameter of sinus of Valsalva, or the distance between the annulus, left coronary leaflet, and the ostium of the left coronary artery, between the patient with and without severe aortic stenosis.

CONCLUSIONS

The MSCT can provide detailed information on the shape of the aortic annulus and the relation between the annulus and the ostia of the coronary arteries. Thereby, MSCT may be helpful for avoiding paravalvular leakage and coronary occlusion and may facilitate the selection of candidates for transcatheter aortic valve replacement.

摘要

目的

在本研究中，采用多层螺旋计算机断层扫描（MSCT）对主动脉根部进行无创解剖评估。

背景

经导管主动脉瓣置换术已被提议作为严重主动脉瓣狭窄高危患者手术的替代方案。对于该手术，需要详细了解主动脉瓣环直径以及瓣环与冠状动脉之间的关系。

方法

对169例患者（111例男性，年龄54±11岁）进行64层MSCT扫描以评估冠状动脉疾病。其中，150例患者无主动脉瓣狭窄或仅有轻度主动脉瓣狭窄，19例患者有中度至重度主动脉瓣狭窄。重建的冠状面和矢状面视图用于在两个方向评估主动脉瓣环直径。此外，评估瓣环与左右冠状动脉开口之间的距离以及冠状瓣叶的长度。在舒张末期的单斜矢状面上分析左心室流出道和室间隔。

结果

冠状面上主动脉瓣环直径为26.3±2.8mm，矢状面上为23.5±2.7mm。这两个直径的平均差值为2.9±1.8mm，表明主动脉瓣环呈椭圆形。主动脉瓣环与右冠状动脉开口之间的平均距离为17.2±3.3mm，与左冠状动脉开口之间的平均距离为14.4±2.9mm。在82例患者（49%）中，左冠状瓣叶的长度超过了瓣环与左冠状动脉开口之间的距离。有严重主动脉瓣狭窄和无严重主动脉瓣狭窄的患者在瓣环直径、主动脉窦直径或瓣环、左冠状瓣叶与左冠状动脉开口之间的距离方面无显著差异。