Wood David A, Tops Laurens F, Mayo John R, Pasupati Sanjeevan, Schalij Martin J, Humphries Karin, Lee May, Al Ali Abdullah, Munt Brad, Moss Rob, Thompson Christopher R, Bax Jeroen J, Webb John G
Division of Cardiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
Am J Cardiol. 2009 May 1;103(9):1295-301. doi: 10.1016/j.amjcard.2009.01.034.
Transcatheter aortic valve replacement (TAVR) required precise knowledge of the anatomic dimensions and physical characteristics of the aortic valve, annulus, and aortic root. Most groups currently use angiography, transthoracic echocardiography (TTE), or transesophageal echocardiography (TEE) to assess aortic annulus dimensions and anatomy. However, multislice computed tomography (MSCT) may allow more detailed 3-dimensional assessment of the aortic root. Twenty-six patients referred for TAVR underwent MSCT. Scans were also obtained for 18 patients after TAVR. All patients underwent pre- and postprocedural aortic root angiography, TTE, and TEE. Mean differences in measured aortic annular diameters were 1.1 mm (95% confidence interval 0.5, 1.8) for calibrated angiography and TTE, -0.9 mm (95% confidence interval -1.7, -0.1 mm) for TTE and TEE, -0.3 mm (95% confidence interval -1.1, 0.6 mm) for MSCT (sagittal) and TTE, and -1.2 mm (95% confidence interval -2.2, -0.2 mm) for MSCT (sagittal) and TEE. Coronal systolic measurements using MSCT, which corresponded to angiographic orientation, were 3.2 mm (1st and 3rd quartiles 2.6, 3.9) larger than sagittal systolic measurements, which were in the same anatomic plane as standard TTE and TEE views. There was no significant association between either shape of the aortic annulus or amount of aortic valve calcium and development of perivalvular aortic regurgitation. After TAVR, the prosthesis extended to or beyond the inferior border of the left main ostium in 9 of 18 patients (50%), and in 11 patients (61%), valvular calcium was <5 mm from the left main ostium. In conclusion, MSCT identified that the aortic annulus was commonly eccentric and often oval. This may in part explain the small, but clinically insignificant, differences in measured aortic annular diameters with other imaging modalities. MSCT after TAVR showed close proximity of both the prosthesis and displaced valvular calcium to the left main ostium in most patients. Neither eccentricity nor calcific deposits appeared to contribute significantly to severity of paravalvular regurgitation after TAVR.
经导管主动脉瓣置换术（TAVR）需要精确了解主动脉瓣、瓣环和主动脉根部的解剖尺寸及物理特征。目前大多数团队使用血管造影、经胸超声心动图（TTE）或经食管超声心动图（TEE）来评估主动脉瓣环尺寸和解剖结构。然而，多层计算机断层扫描（MSCT）可能会对主动脉根部进行更详细的三维评估。26例拟行TAVR的患者接受了MSCT检查。18例TAVR术后患者也进行了扫描。所有患者在术前和术后均接受了主动脉根部血管造影、TTE和TEE检查。校准血管造影与TTE测量的主动脉瓣环直径平均差值为1.1毫米（95%置信区间0.5, 1.8），TTE与TEE为-0.9毫米（95%置信区间-1.7, -0.1毫米），MSCT（矢状面）与TTE为-0.3毫米（95%置信区间-1.1, 0.6毫米），MSCT（矢状面）与TEE为-1.2毫米（95%置信区间-2.2, -0.2毫米）。与血管造影方向对应的MSCT冠状面收缩期测量值比与标准TTE和TEE视图处于同一解剖平面的矢状面收缩期测量值大3.2毫米（第1和第3四分位数为2.6, 3.9）。主动脉瓣环形状或主动脉瓣钙化量与瓣周主动脉反流的发生之间均无显著关联。TAVR术后，18例患者中有9例（50%）人工瓣膜延伸至左主开口下缘或其下方，11例患者（61%）瓣膜钙化距左主开口<5毫米。总之，MSCT显示主动脉瓣环通常是偏心的且常呈椭圆形。这可能部分解释了与其他成像方式相比，测量的主动脉瓣环直径存在虽小但临床上无显著意义的差异。TAVR术后的MSCT显示，大多数患者的人工瓣膜和移位的瓣膜钙化都与左主开口紧密相邻。偏心或钙化沉积似乎均未对TAVR术后瓣周反流的严重程度产生显著影响。
