Ouweneel Dagmar M, Sjauw Krischan D, Wiegerinck Esther M A, Hirsch Alexander, Baan Jan, de Mol Bas A J M, Lagrand Wim K, Planken R Nils, Henriques José P S
1AMC Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.2Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.3Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Crit Care Med. 2016 Oct;44(10):e957-63. doi: 10.1097/CCM.0000000000001858.
The use of intracardiac assist devices is expanding, and correct position of these devices is required for optimal functioning. The aortic valve is an important landmark for positioning of those devices. It would be of great value if the device position could be easily monitored on plain supine chest radiograph in the ICU. We introduce a ratio-based tool for determination of the aortic valve location on plain supine chest radiograph images, which can be used to evaluate intracardiac device position.
Retrospective observational study.
Large academic medical center.
Patients admitted to the ICU and supported by an intracardiac assist device.
We developed a ratio to determine the aortic valve location on supine chest radiograph images. This ratio is used to assess the position of a cardiac assist device and is compared with echocardiographic findings.
Supine anterior-posterior chest radiographs of patients with an aortic valve prosthesis (n = 473) were analyzed to determine the location of the aortic valve. We calculated several ratios with the potential to determine the position of the aortic valve. The aortic valve location ratio, defined as the distance between the carina and the aortic valve, divided by the thoracic width, was found to be the best performing ratio. The aortic valve location ratio determines the location of the aortic valve caudal to the carina, at a distance of 0.25 ± 0.05 times the thoracic width for male patients and 0.28 ± 0.05 times the thoracic width for female patients. The aortic valve location ratio was validated using CT images of patients with angina pectoris without known valvular disease (n = 95). There was a good correlation between cardiac device position (Impella) assessed with the aortic valve location ratio and with echocardiography (n = 53).
The aortic valve location ratio enables accurate and reproducible localization of the aortic valve on supine chest radiograph. This tool is easily applicable and can be used for assessment of cardiac device position in patients on the ICU.
心内辅助装置的使用正在增加，这些装置的正确位置对于最佳功能是必需的。主动脉瓣是这些装置定位的重要标志。如果能在重症监护病房（ICU）的仰卧位胸部平片上轻松监测装置位置，将具有很大价值。我们介绍一种基于比率的工具，用于在仰卧位胸部平片图像上确定主动脉瓣位置，该工具可用于评估心内装置位置。
回顾性观察研究。
大型学术医疗中心。
入住ICU并由心内辅助装置支持的患者。
我们开发了一个比率来确定仰卧位胸部平片图像上的主动脉瓣位置。该比率用于评估心脏辅助装置的位置，并与超声心动图检查结果进行比较。
分析了有主动脉瓣人工瓣膜的患者（n = 473）的仰卧前后位胸部平片，以确定主动脉瓣的位置。我们计算了几个有可能确定主动脉瓣位置的比率。发现主动脉瓣位置比率（定义为隆突与主动脉瓣之间的距离除以胸廓宽度）是表现最佳的比率。主动脉瓣位置比率确定了主动脉瓣在隆突下方的位置，男性患者距离为胸廓宽度的0.25±0.05倍，女性患者为胸廓宽度的0.28±0.05倍。使用无已知瓣膜疾病的心绞痛患者（n = 95）的CT图像对主动脉瓣位置比率进行了验证。用主动脉瓣位置比率评估的心脏装置位置（Impella）与超声心动图（n = 53）之间存在良好的相关性。
主动脉瓣位置比率能够在仰卧位胸部平片上准确且可重复地定位主动脉瓣。该工具易于应用，可用于评估ICU患者的心脏装置位置。
