Suchá Dominika, Daans Ceranza G, Symersky Petr, Planken R Nils, Mali Willem P Th M, van Herwerden Lex A, Budde Ricardo P J
Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Am J Cardiol. 2015 Jul 1;116(1):112-20. doi: 10.1016/j.amjcard.2015.03.048. Epub 2015 Apr 8.
The implanted prosthetic heart valve (PHV) size is vital for the evaluation of suspected PHV dysfunction and in case of reoperation or valve-in-valve transcatheter approaches. The labeled size is not always known, and discrepancies exist between manufacturers' labeled sizes and true sizes. Reproducible methods for noninvasive PHV size assessment are lacking. We determined the reliability and agreement of PHV size measurements using multidetector-row computed tomography (MDCT) and provide reference values of MDCT measurements compared with manufacturer specifications. In vitro, 15 different PHV types in available sizes (total n = 63) were imaged. In vivo, available MDCT acquisitions of patients with PHVs were retrospectively gathered in 2 centers, and 230 patients with 249 PHVs were included. Inner valve area and area-derived diameter were measured in all PHVs. For mechanical PHVs, the inner diameter was also measured. Data were analyzed using the intraclass correlation coefficient and Bland-Altman plots and related to manufacturer specifications. Measurements could be obtained for all PHV types, except the Björk-Shiley (n = 7) because of severe valve-related artifacts hampering the image quality. Intrarater and interrater reliability was excellent for biological and mechanical PHVs (intraclass correlation coefficients ≥0.903). Agreement was good for all measurements with an overall maximal mean difference (95% confidence interval) of -2.61 mm(2) (-37.9 to 32.7), -0.1 mm (-1.1 to 1.0), and 0 mm (-0.4 to 0.3) for valve area, area-derived diameter, and inner diameter, respectively. MDCT reliably discriminated consecutive PHV sizes as labeled by the manufacturer because the absolute ranges for the measurements never overlapped. In conclusion, MDCT allows assessment of the implanted PHV size with excellent reliability and agreement and can discriminate between PHV sizes for contemporary prostheses. MDCT can be used to noninvasively identify the manufacturer-labeled PHV size.
植入式人工心脏瓣膜（PHV）的尺寸对于评估疑似PHV功能障碍以及再次手术或瓣中瓣经导管治疗的情况至关重要。标记尺寸并不总是已知的，并且制造商标记尺寸与实际尺寸之间存在差异。目前缺乏用于无创评估PHV尺寸的可重复方法。我们确定了使用多排探测器计算机断层扫描（MDCT）测量PHV尺寸的可靠性和一致性，并提供了与制造商规格相比的MDCT测量参考值。在体外，对15种不同尺寸的可用PHV类型进行成像（总数n = 63）。在体内，在2个中心回顾性收集了有PHV患者的可用MDCT图像，纳入了230例患者的249个PHV。测量了所有PHV的瓣膜内面积和面积衍生直径。对于机械PHV，还测量了内径。使用组内相关系数和Bland-Altman图分析数据，并与制造商规格相关联。除了Björk-Shiley瓣膜（n = 7）外，所有PHV类型均能获得测量结果，因为严重的瓣膜相关伪影妨碍了图像质量。生物和机械PHV的测量者内和测量者间可靠性极佳（组内相关系数≥0.903）。所有测量的一致性良好，瓣膜面积、面积衍生直径和内径的总体最大平均差异（95%置信区间）分别为-2.61 mm²（-37.9至32.7）、-0.1 mm（-1.1至1.0）和0 mm（-0.4至0.3）。MDCT能够可靠地区分制造商标记的连续PHV尺寸，因为测量的绝对范围从不重叠。总之，MDCT能够以极佳的可靠性和一致性评估植入的PHV尺寸，并能区分当代假体的PHV尺寸。MDCT可用于无创识别制造商标记的PHV尺寸。
