Zhou Qijing, Liu Xianbao, Dong Aiqiang, Pu Zhaoxia, He Wei, Feng Yan, Wang Jian'an
Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China.
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Zhonghua Xin Xue Guan Bing Za Zhi. 2014 Oct;42(10):835-9.
To evaluate the value of preoperative assessment on transcatheter aortic valve implantation (TAVI) procedure with high-pitch dual-source computed tomography angiography (CTA).
Seventeen consecutive patients with severe symptomatic aortic stenosis underwent TAVI in our department from December 2012 to December 2013 were examined by 128-slice prospective ECG-triggered high-pitch spiral CTA and the clinical data were analyzed. Aortic annulus, sinus of Valsalva, sinotubular junction, ascending aorta and native leaflet to coronary ostium length were measured. Peripheral vascular access was evaluated. Then the patients were assessed on the suitability for TAVI procedure and prosthetic valve sizes.
Mean diameter of the aortic annulus was (25.7 ± 2.0) mm, perimeter mean diameter was (26.4 ± 2.0) mm, area mean diameter was (25.4 ± 1.9) mm. Mean diameter of sinus of Valsalva was (34.0 ± 3.8) mm. Mean diameter of sinotubular junction was (30.5 ± 3.2) mm. Mean diameter of ascending aorta was (37.8 ± 2.8) mm. The length from native leaflet to left coronary ostium was (14.0 ± 2.0) mm, and the length from native leaflet to right coronary ostium was (15.9 ± 3.6) mm. Mean diameter of left iliac arteries was (7.5 ± 1.4) mm. Mean diameter of right iliac arteries was (7.4 ± 1.2) mm. Mean diameter of left femoral arteries was (7.4 ± 1.2) mm. Mean diameter of right femoral arteries was (7.3 ± 1.3) mm. One patient was considered ineligible for TAVI because of large aortic annulus diameter. Three patients died prior to TAVI. Two patients refused to undergo TAVI. Eleven patients underwent TAVI, 26# prosthetic valve was implanted in 1 patient, 29# prosthetic valve implanted in 6 patients, 31# prosthetic valve implanted in 4 patients. Prosthetic valve implantation was successful in 9 patients and only mild or trace perivalvular leakage was observed in these patients. Moderate perivalvular leakage were observed in 2 patients because of the location of implantation was too low, and perivalvular leakage was significantly reduced after re-implantation with same size prosthetic valve at a higher location.
CTA can be used to evaluate the aortic root anatomy and vascular access, and help to choose the right size of prosthetic valve. CTA has an important practical value in preoperative screening of TAVI procedure.
评估高分辨率双源计算机断层扫描血管造影（CTA）对经导管主动脉瓣植入术（TAVI）术前评估的价值。
对2012年12月至2013年12月在我科连续接受TAVI治疗的17例有症状的严重主动脉瓣狭窄患者进行128层前瞻性心电图触发高分辨率螺旋CTA检查，并分析临床资料。测量主动脉瓣环、主动脉窦、窦管交界、升主动脉以及天然瓣叶至冠状动脉开口的长度。评估外周血管通路。然后评估患者是否适合TAVI手术以及人工瓣膜的尺寸。
主动脉瓣环平均直径为（25.7±2.0）mm，周长平均直径为（26.4±2.0）mm，面积平均直径为（25.4±1.9）mm。主动脉窦平均直径为（34.0±3.8）mm。窦管交界平均直径为（30.5±3.2）mm。升主动脉平均直径为（37.8±2.8）mm。天然瓣叶至左冠状动脉开口的长度为（14.0±2.0）mm，天然瓣叶至右冠状动脉开口的长度为（15.9±3.6）mm。左髂动脉平均直径为（7.5±1.4）mm。右髂动脉平均直径为（7.4±1.2）mm。左股动脉平均直径为（
