Curran Lara, Agrawal Harsh, Kallianos Kimberly, Kheiwa Ahmed, Lin Shezhang, Ordovas Karen, Mahadevan Vaikom S
Department of Cardiology, University of California, San Francisco, United States.
Department of Radiology and Biomedical Imaging, University of California, San Francisco, United States.
Int J Cardiol Heart Vasc. 2020 Apr 28;29:100523. doi: 10.1016/j.ijcha.2020.100523. eCollection 2020 Aug.
To evaluate the predictive value of Computed Tomography Angiography (CTA) measurements of the RVOT for transcatheter valve sizing.
Transcatheter pulmonary valve replacement (TPVR) provides an alternative to surgery in patients with right ventricular outflow tract (RVOT) dysfunction. We studied 18 patients who underwent catheterization for potential TPVR to determine whether CT imaging can be used to accurately predict implant size.
Cases were grouped by RVOT characteristics: native or transannular patch (n = 8), conduit (n = 5) or bioprosthetic valve (n = 5). TPVR was undertaken in 14/18 cases, after balloon-sizing was used to confirm suitability and select implant size. Retrospective CT measurements of the RVOT (circumference-derived (D) and area-derived (D) diameters) were obtained at the level of the annulus, bioprosthesis or conduit. Using manufacturer sizing guidance, a valve size was generated and a predicted valve category assigned: (1) <18 mm, (2) 18-20 mm, (3) 22-23 mm, (4) 26-29 mm and (5) >29 mm. Predicted and implanted valves were compared for inter-rater agreement using Cohen's kappa coefficient.
The median age of patients was 37 years old (IQR: 30-49); 55% were male. Diagnoses included: Tetralogy of Fallot (12/18), d-Transposition repair (3/18), congenital pulmonary stenosis (2/18) and carcinoid heart disease (1/18). Measurements of D (κ = 0.697, p < 0.01) and D (κ = 0.540, p < 0.01) were good predictors of implanted valve size. When patients with RVOT conduits were excluded, the predictive accuracy improved for D (κ = 0.882, p < 0.01) and D (κ = 0.882, p < 0.01).
CT measurement of the RVOT, using D or D, can predict prosthetic valve sizing in TPVR. These measurements are less predictive in patients with conduits, compared to those with a native RVOT or pulmonic bioprosthesis.
We studied 18 patients who underwent catheterization for TPVR to determine whether CT imaging could be used to accurately predict implant size. Retrospective RVOT measurements were used to generate a predicted valve size, which was compared with implanted valve size for inter-rater agreement. Measurements of D (κ = 0.697, p < 0.01) and D (κ = 0.540, p < 0.01) were good predictors of implanted valve size. When cases with RVOT conduits were excluded, the predictive accuracy improved for D (κ = 0.882, p < 0.01) and D (κ = 0.882, p < 0.01). CT measurement of the RVOT can accurately predict prosthetic valve sizing in TPVR. These measurements are less predictive in patients with conduits.
评估右心室流出道（RVOT）的计算机断层血管造影（CTA）测量值对经导管瓣膜尺寸选择的预测价值。
经导管肺动脉瓣置换术（TPVR）为右心室流出道功能障碍患者提供了一种手术替代方案。我们研究了18例因可能接受TPVR而接受导管检查的患者，以确定CT成像是否可用于准确预测植入瓣膜的尺寸。
根据RVOT特征对病例进行分组：天然或跨环补片（n = 8）、人工血管（n = 5）或生物瓣膜（n = 5）。14/18例患者接受了TPVR，术前通过球囊扩张来确认适用性并选择植入瓣膜的尺寸。在瓣环、生物瓣膜或人工血管水平对RVOT进行回顾性CT测量（周长衍生直径（D）和面积衍生直径（D））。根据制造商的尺寸指南，确定瓣膜尺寸并指定预测的瓣膜类别：（1）<18 mm，（2）18 - 20 mm，（3）22 - 23 mm，（4）26 - 29 mm和（5）>29 mm。使用Cohen卡方系数比较预测瓣膜和植入瓣膜之间的评分者间一致性。
患者的中位年龄为37岁（四分位间距：30 - 49岁）；55%为男性。诊断包括：法洛四联症（12/18）；d型大动脉转位修复术后（3/18）、先天性肺动脉狭窄（2/18）和类癌性心脏病（1/18）。D（κ = 0.697，p < 0.01）和D（κ = 0.540，p < 0.01）测量值是植入瓣膜尺寸的良好预测指标。排除RVOT人工血管患者后，D（κ = 0.882，p < 0.01）和D（κ = 0.882，p < 0.01）的预测准确性提高。
使用D或D对RVOT进行CT测量可预测TPVR中的人工瓣膜尺寸。与天然RVOT或肺动脉生物瓣膜患者相比，这些测量值对人工血管患者的预测性较差。
我们研究了18例因TPVR接受导管检查的患者，以确定CT成像是否可用于准确预测植入瓣膜的尺寸。回顾性RVOT测量用于确定预测瓣膜尺寸，并与植入瓣膜尺寸比较以评估评分者间一致性。D（κ = 0.697，p < 0.01）和D（κ = 0.540，p < 0.01）测量值是植入瓣膜尺寸的良好预测指标。排除RVOT人工血管病例后，D（κ = 0.882，p < 0.01）和D（κ = 0.882，p < 0.01）的预测准确性提高。RVOT的CT测量可准确预测TPVR中的人工瓣膜尺寸。这些测量值对人工血管患者的预测性较差。
