Department of Cardiology, University of Health Sciences, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Turkey.
Department of Radiology, University of Health Sciences, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Turkey.
Anatol J Cardiol. 2022 Jul;26(7):532-542. doi: 10.5152/AnatolJCardiol.2022.987.
The right fibrous trigone, which the His bundle penetrates, is part of the subaortic area adjacent to the membranous septum. Structural alterations of the right fibrous trigone may cause conduction disturbance as a result of compression in this area after transcatheter aortic valve implantation. This study analyzed the hypothesis of whether imaging parameters of the RFT could predict the risk of conduction disturbance after transcatheter aortic valve implantation.
We retrospectively examined 209 patients who underwent transfemoral transcatheter aortic valve implantationat a tertiary cardiac center. The different valve models were divided into 2 groups: self-expanding valve and balloon-expandable valve. Using pre-procedure computed tomography, we evaluated for the alterations of the right fibrous trigone.
New conduction disturbance was seen in 75 of 209 (35.8%) patients. Receiver operating characteristics plots displayed a right fibrous trigone density of -6 Hounsfieldunit for SEV and -16 Hounsfield unit for balloon-expandable valve as the optimal cut- off points for prediction conduction disturbance. In multiple regression analyses, the high density of RFT emerged as an independent predictor of conduction disturbance in both the self-expanding valve (odds ratio: 1.01, 95% CI: 1.01 to 1.02, P = 0.035) and bal- loon-expandable valve (odds ratio: 1.01, 95% CI: 1.01 to 1.03, P = 0.017) groups. A shorter membranous septum length and a greater implantation depth were also found to be significantly associated with a higher incidence of conduction disturbance in both trans- catheter aortic valve implantation groups.
High density of right fibrous trigone is independently associated with con- duction disturbance after transcatheter aortic valve implantation, and its pre-proce- dure computed tomography evaluation can help predict the new-onset of conduction disturbance.
希氏束穿过的右侧纤维三角是毗邻膜部间隔的主动脉瓣下区域的一部分。右侧纤维三角的结构改变可能会导致经导管主动脉瓣植入术后该区域受压而引起传导障碍。本研究分析了右侧纤维三角的影像学参数是否可以预测经导管主动脉瓣植入术后传导障碍的风险。
我们回顾性分析了在一家三级心脏中心接受经股动脉经导管主动脉瓣植入术的 209 例患者。根据不同的瓣膜模型将患者分为 2 组：自膨式瓣膜和球囊扩张式瓣膜。使用术前计算机断层扫描评估右侧纤维三角的改变。
209 例患者中有 75 例（35.8%）出现新发传导障碍。受试者工作特征曲线显示，对于自膨式瓣膜和球囊扩张式瓣膜，右侧纤维三角密度-6 亨氏单位和-16 亨氏单位分别为预测传导障碍的最佳截断点。多因素回归分析显示，在自膨式瓣膜（比值比：1.01，95%置信区间：1.01 至 1.02，P = 0.035）和球囊扩张式瓣膜（比值比：1.01，95%置信区间：1.01 至 1.03，P = 0.017）组中，右侧纤维三角的高密度均为传导障碍的独立预测因子。较短的膜部间隔长度和较大的植入深度也与两组经导管主动脉瓣植入患者的传导障碍发生率较高显著相关。
右侧纤维三角的高密度与经导管主动脉瓣植入术后的传导障碍独立相关，其术前计算机断层扫描评估有助于预测新发传导障碍。
