Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Freiburgstrasse, Bern, Switzerland.
JACC Cardiovasc Interv. 2013 Jan;6(1):72-83. doi: 10.1016/j.jcin.2012.09.007.
The aim of this study was to characterize aortic root dimensions of patients with aortic valve stenosis undergoing transcatheter aortic valve replacement (TAVR) and to evaluate sex differences.
The advent of TAVR makes a precise delineation of the aortic root anatomy mandatory and requires a profound anatomic understanding.
Patients planned to undergo TAVR underwent screening imaging with use of a 64-slice or dual-source electrocardiogram-gated contrast-enhanced computed tomography. Anatomic dimensions were assessed at the level of the left ventricular outflow tract (LVOT), annulus, sinus of Valsalva, and ascending aorta.
The study population comprised 80 men and 97 women (age: 82 ± 6 years) with symptomatic severe aortic valve stenosis. Multislice computed tomography aortic root assessment revealed larger annular and LVOT dimensions in men than women (area annulus: 483.1 ± 75.6 mm(2) vs. 386.9 ± 58.5 mm(2), p = 0.0002; area LVOT: 478.2 ± 131.0 mm(2) vs. 374.0 ± 94.2 mm(2), p = 0.0024), whereas dimensions of the ascending aorta were comparable. Both LVOT and annulus were predominantly oval without sex differences, with a higher mean ellipticity index for the LVOT compared with the annulus (1.49 ± 0.2 vs. 1.29 ± 0.1); the ascending aorta was primarily circular (1.07 ± 0.1). Although similar in mean surface area, an area mismatch of annulus and LVOT of more than 10%, 20%, and 40% was detected in 42, 9, and 2 patients, respectively. The mean distance from annulus to the left coronary ostium was smaller than the mean distance of the right coronary ostium (14.4 ± 3.6 mm vs. 16.7 ± 3.6 mm), and distances were lower among women than men.
The aortic root has specific anatomic characteristics, which affect device design, selection, and clinical outcome in patients undergoing TAVR. Female sex is associated with smaller annular and LVOT but not aortic dimensions. The degree of ellipticity as well as a significant mismatch between annular and LVOT dimensions in selected patients deserve careful evaluation.
本研究旨在描述行经导管主动脉瓣置换术（TAVR）的主动脉瓣狭窄患者的主动脉根部尺寸，并评估性别差异。
TAVR 的出现使得精确描绘主动脉根部解剖结构成为必要，并需要深入了解解剖结构。
计划行经 TAVR 的患者接受了使用 64 层或双源心电图门控对比增强 CT 进行的筛查成像。在左心室流出道（LVOT）、瓣环、瓦尔萨尔瓦窦和升主动脉水平评估解剖尺寸。
研究人群包括 80 名男性和 97 名女性（年龄：82 ± 6 岁），均患有症状性严重主动脉瓣狭窄。多层 CT 主动脉根部评估显示男性的瓣环和 LVOT 尺寸大于女性（瓣环面积：483.1 ± 75.6 mm² vs. 386.9 ± 58.5 mm²，p = 0.0002；LVOT 面积：478.2 ± 131.0 mm² vs. 374.0 ± 94.2 mm²，p = 0.0024），而升主动脉尺寸相当。LVOT 和瓣环均主要呈椭圆形，无性别差异，但 LVOT 的平均椭圆率指数高于瓣环（1.49 ± 0.2 vs. 1.29 ± 0.1）；升主动脉主要呈圆形（1.07 ± 0.1）。尽管平均表面积相似，但仍有 42 例、9 例和 2 例患者的瓣环和 LVOT 面积差异超过 10%、20%和 40%。瓣环到左冠状动脉开口的平均距离小于右冠状动脉开口的平均距离（14.4 ± 3.6 mm 比 16.7 ± 3.6 mm），且女性的距离小于男性。
主动脉根部具有特定的解剖特征，这会影响行经 TAVR 的患者的器械设计、选择和临床结果。女性与较小的瓣环和 LVOT 但不是升主动脉尺寸相关。在某些患者中，椭圆率的程度以及瓣环和 LVOT 尺寸之间的显著不匹配值得仔细评估。
Zotero 插件