Queirós Sandro, Morais Pedro, Fehske Wolfgang, Papachristidis Alexandros, Voigt Jens-Uwe, Fonseca Jaime C, D'hooge Jan, Vilaça João L
Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal.
ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.
Int J Cardiovasc Imaging. 2019 May;35(5):881-895. doi: 10.1007/s10554-019-01532-w. Epub 2019 Jan 30.
The assessment of aortic valve (AV) morphology is paramount for planning transcatheter AV implantation (TAVI). Nowadays, pre-TAVI sizing is routinely performed at one cardiac phase only, usually at mid-systole. Nonetheless, the AV is a dynamic structure that undergoes changes in size and shape throughout the cardiac cycle, which may be relevant for prosthesis selection. Thus, the aim of this study was to present and evaluate a novel software tool enabling the automatic sizing of the AV dynamically in three-dimensional (3D) transesophageal echocardiography (TEE) images. Forty-two patients who underwent preoperative 3D-TEE images were retrospectively analyzed using the software. Dynamic measurements were automatically extracted at four levels, including the aortic annulus. These measures were used to assess the software's ability to accurately and reproducibly quantify the conformational changes of the aortic root and were validated against automated sizing measurements independently extracted at distinct time points. The software extracted physiological dynamic measurements in less than 2 min, that were shown to be accurate (error 2.2 ± 26.3 mm and 0.0 ± 2.53 mm for annular area and perimeter, respectively) and highly reproducible (0.85 ± 6.18 and 0.65 ± 7.90 mm of intra- and interobserver variability, respectively, in annular area). Using the maximum or minimum measured values rather than mid-systolic ones for device sizing resulted in a potential change of recommended size in 7% and 60% of the cases, respectively. The presented software tool allows a fast, automatic and reproducible dynamic assessment of the AV morphology from 3D-TEE images, with the extracted measures influencing the device selection depending on the cardiac moment used to perform its sizing. This novel tool may thus ease and potentially increase the observer's confidence during prosthesis' size selection at the preoperative TAVI planning.
主动脉瓣（AV）形态评估对于经导管主动脉瓣植入术（TAVI）的规划至关重要。如今，TAVI术前尺寸测量通常仅在一个心动周期阶段进行，通常是在收缩中期。然而，主动脉瓣是一个动态结构，在整个心动周期中其大小和形状都会发生变化，这可能与假体选择有关。因此，本研究的目的是展示和评估一种新型软件工具，该工具能够在三维（3D）经食管超声心动图（TEE）图像中动态自动测量主动脉瓣尺寸。使用该软件对42例接受术前3D-TEE图像检查的患者进行回顾性分析。在四个层面自动提取动态测量值，包括主动脉瓣环。这些测量值用于评估该软件准确且可重复量化主动脉根部形态变化的能力，并与在不同时间点独立提取的自动尺寸测量值进行验证。该软件在不到2分钟的时间内提取出生理动态测量值，结果显示这些测量值准确（瓣环面积和周长的误差分别为2.2±26.3毫米和0.0±2.53毫米）且具有高度可重复性（瓣环面积的观察者内和观察者间变异性分别为0.85±6.18毫米和0.65±7.90毫米）。使用测量的最大值或最小值而非收缩中期值进行器械尺寸确定，分别导致7%和60%的病例中推荐尺寸可能发生变化。所展示的软件工具能够从3D-TEE图像中快速、自动且可重复地动态评估主动脉瓣形态，提取的测量值会根据用于尺寸确定的心动时刻影响器械选择。因此，这种新型工具可能会在术前TAVI规划的假体尺寸选择过程中减轻观察者的负担并可能增加其信心。
