Department of Radiology, Innsbruck Medical University, Innsbruck, Austria.
Ann Thorac Surg. 2012 Dec;94(6):1961-6. doi: 10.1016/j.athoracsur.2012.06.044. Epub 2012 Aug 24.
Transcatheter aortic valve implantation (TAVI) has emerged as an alternative treatment for high-risk and inoperable patients. Advanced multimodality imaging, including computed tomography (CT), plays a key role for optimized planning of TAVI.
Forty-nine patients (25 women; age, 82.3±8.8 year) with severe aortic stenosis scheduled for TAVI were examined with 128-slice high-pitch dual-source prospective aortoiliac CT angiography (CTA). The 3-coronary-sinus-alignment (3-CSA) plane, comprising left and right anterior oblique and craniocaudal projection, was defined from three-dimensional volume-rendered technique data sets and compared with the intraoperative angiographic plane (deployment plane) used for device implantation. A tolerance level of ±5-degree deviation was acceptable. Volume of intraoperative iodine contrast agent was compared before and after the implementation of the 3-CSA plane estimation by CT.
All 49 patients underwent TAVI, during which 6 CoreValves (Medtronic, Minneapolis, MN) and 43 Sapien valves (Edwards Lifesciences, Irvine, CA) were successfully implanted using transapical (n=29), transfemoral (n=17), and transaxillary access (n=4). No severe complications occurred. In 47 patients (96%), CTA correctly predicted the 3-CSA plane used for device implantation. Mean left anterior oblique by CTA was 5.3±6.5 degrees and craniocaudal was -1.3±10.1 degrees. Mean left anterior oblique deviation between CTA and the intraoperative projection was 2.1±2.7 degrees and craniocaudal was 1.7±3.0 degrees. Ostium heights of the right and left coronary arteries were 12±1.9 and 12.9±3.3 mm. No over-stenting occurred in left coronary artery ostia of 8 mm or more. Contrast volume was reduced from 81.8±25.6 to 59.4±40.2 mL (p=0.05) when using 3-CSA plane estimation by CT for final prosthesis implantation plane.
Aortoiliac high-pitch 128-slice dual-source CT contributes to TAVI planning, including reliable prediction of the 3-CSA valve deployment plane, which saves contrast volume during the procedure and may facilitate correct valve placement.
经导管主动脉瓣植入术（TAVI）已成为高危和不可手术患者的一种替代治疗方法。先进的多模态成像技术，包括计算机断层扫描（CT），在 TAVI 的优化规划中发挥着关键作用。
49 名（25 名女性；年龄 82.3±8.8 岁）拟行 TAVI 的严重主动脉瓣狭窄患者接受了 128 层高分辨率双源前瞻性主动脉髂动脉 CT 血管造影（CTA）检查。从三维容积再现技术数据集定义了包含左前斜位和右前斜位以及头侧尾侧投影的 3-冠状窦对齐（3-CSA）平面，并与用于器械植入的术中血管造影平面（植入平面）进行了比较。可接受的容差水平为±5 度偏差。比较了在实施 3-CSA 平面估计之前和之后术中碘造影剂的体积。
所有 49 名患者均成功进行了 TAVI，其中 6 个 CoreValves（美敦力，明尼苏达州明尼阿波利斯）和 43 个 Sapien 瓣膜（爱德华兹生命科学公司，欧文，加利福尼亚州）经经心尖（n=29）、经股动脉（n=17）和经腋动脉入路（n=4）成功植入。无严重并发症发生。在 47 名患者（96%）中，CTA 正确预测了用于器械植入的 3-CSA 平面。CTA 左前斜位平均为 5.3±6.5 度，头侧尾侧为-1.3±10.1 度。CTA 与术中投影之间左前斜位的平均偏差为 2.1±2.7 度，头侧尾侧为 1.7±3.0 度。右冠状动脉和左冠状动脉开口高度分别为 12±1.9mm 和 12.9±3.3mm。左冠状动脉开口 8mm 或以上的支架均未过度扩张。当使用 CT 进行最终假体植入平面的 3-CSA 平面估计时，造影剂体积从 81.8±25.6 减少至 59.4±40.2ml（p=0.05）。
主动脉髂动脉高分辨率 128 层双源 CT 有助于 TAVI 规划，包括可靠预测 3-CSA 瓣膜植入平面，可在手术过程中节省造影剂用量，并有助于正确放置瓣膜。
