St Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
JACC Cardiovasc Interv. 2010 Nov;3(11):1157-65. doi: 10.1016/j.jcin.2010.09.010.
This study assessed whether multislice computed tomography (MSCT) could predict optimal angiographic projections for visualizing the plane of the native valve and facilitate accurate positioning during transcatheter aortic valve implantation (TAVI).
Accurate device positioning during TAVI depends on valve deployment in angiographic projections perpendicular to the native valve plane, but these may be difficult to determine.
Twenty patients underwent MSCT before TAVI. Using a novel technique, multiple angiographic projections accurately representing the native valve plane in multiple axes were determined. The accuracy of all predicted projections was determined post-procedure using angiography according to new criteria, based on valve perpendicularity and the degree of strut overlap (defined as excellent, satisfactory, or poor). The accuracy of valve deployment using MSCT was compared with the results of 20 consecutive patients undergoing TAVI without such MSCT angle prediction.
Correct final deployment projections were more frequent in the MSCT-guided compared with non-MSCT-guided group: excellent or satisfactory projections (90% vs. 65%, p = 0.06). The MSCT angle prediction was accurate but dependent on optimal images (optimal images: 93% of predicted angles were excellent or satisfactory, suboptimal images: 73% of predicted angles were poor). A "line of perpendicularity" could be generated with optimal projections across the right-to-left anterior oblique plane by adding the correct cranial or caudal angulation.
Pre-procedural MSCT can predict optimal angiographic deployment projections for implantation of transcatheter valves. An ideal deployment angle curve or "line of perpendicularity" can be generated. Understanding and applying these principles improves the accuracy of valve deployment and may improve outcomes.
本研究旨在评估多层螺旋 CT（MSCT）是否可预测用于可视化原生瓣平面的最佳血管造影投影，并有助于经导管主动脉瓣植入（TAVI）过程中的准确定位。
TAVI 过程中器械的准确定位取决于在与原生瓣平面垂直的血管造影投影中瓣膜的展开情况，但这些可能难以确定。
20 例患者在 TAVI 前接受 MSCT 检查。使用一种新方法，确定了多个在多个轴线上准确代表原生瓣平面的多个血管造影投影。根据新的标准（基于瓣膜垂直度和支架重叠程度[定义为优秀、满意或较差]），根据术后血管造影结果确定所有预测投影的准确性。比较了 MSCT 引导与 20 例连续无 MSCT 角度预测的 TAVI 患者的瓣膜部署准确性。
MSCT 引导组的最终正确部署投影较非 MSCT 引导组更频繁：优秀或满意的投影（90% vs. 65%，p = 0.06）。MSCT 角度预测准确，但依赖于最佳图像（最佳图像：93%的预测角度为优秀或满意，次优图像：73%的预测角度为较差）。通过在右前斜位上添加正确的头侧或尾侧角度，可生成具有最佳投影的“垂线”。
术前 MSCT 可预测用于植入经导管瓣膜的最佳血管造影部署投影。可生成理想的部署角度曲线或“垂线”。理解和应用这些原则可提高瓣膜部署的准确性，并可能改善结果。
