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Pre-Procedural Imaging of Aortic Root Orientation and Dimensions

Comparison Between X-Ray Angiographic Planar Imaging and 3-Dimensional Multidetector Row Computed Tomography

Vikram Kurra, MD^_*,, Samir R. Kapadia, MD^_*, E. Murat Tuzcu, MD^_*, Sandra S. Halliburton, PhD^_*,, Lars Svensson, MD^_*, Eric E. Roselli, MD^_*, Paul Schoenhagen, MD^_*,,_*

^_* Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
Imaging Institute, Cleveland Clinic, Cleveland, Ohio

^_* Reprint requests and correspondence: Dr. Paul Schoenhagen, Imaging Institute and Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J1-4, Cleveland, Ohio 44195 (Email: schoenp1{at}ccf.org).

Objectives: We sought to examine whether contrast-enhanced multidetector row computed tomography (MDCT) allows prediction of X-ray angiographic planes for the root angiogram in the context of transcatheter aortic valve implantation.

Background: Understanding of aortic root orientation relative to the body axis is critical for precise positioning of the stent/valve during transcatheter aortic valve implantation.

Methods: Forty patients with severe aortic stenosis underwent conventional X-ray angiography and contrast-enhanced MDCT of the aortic root. Oblique MDCT images of the aortic root, corresponding to X-ray angiographic left anterior oblique (LA)/right anterior oblique (RAO) projections, were created. The cranial/caudal angulation was compared between angiographic and reformatted MDCT images. In addition, root diameter measurements were compared.

Results: The cranial angulation in the LAO X-ray angiograms (mean LAO: 39± 8, n = 38) and matched MDCT images were not significantly different (cranial: 25 ± 7 vs. 23 ± 8; p = 0.214). There was a small but significant difference between the caudal angulation in the RAO angiogram (mean RAO: 25 ± 5, n = 40) and matched CT images (caudal: 21 ± 9 vs. 29 ± 10; p = 0.002). The annulus diameter in the LAO projection was not significantly different between X-ray angiography and contrast-enhanced MDCT (2.3 ± 0.3 vs. 2.4 ± 0.3; p = 0.052), whereas there was a small but significant difference in the annulus diameter in RAO projections between angiography and MDCT (2.4 ± 0.3 vs. 2.2 ± 0.3; p = 0.029).

Conclusions: Pre-procedural contrast-enhanced MDCT imaging of the aortic root allows prediction of X-ray angiographic planes and contributes to planning of the transcatheter aortic valve implantation.

Key Words: multidetector computed tomography • angiography • transcatheter aortic valve implantation • aortic stenosis • aortic valve

Abbreviations and Acronyms   3D = 3-dimensional   LAO = left anterior oblique   MDCT = multidetector row computed tomography   RAO = right anterior oblique   TAVI = transcatheter aortic valve insertion