Pre-Procedural Imaging of Aortic Root Orientation and DimensionsComparison 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
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Figure 1 Conventional Root Angiogram
The current standard root assessment in the context of transcatheter aortic valve insertion is based on the identification of root angiograms before the procedure. In this X-ray angiogram of the aortic root, the valve plane, and the sinuses of Valsalva are illustrated. LCC = left coronary cusp; NCC = noncoronary cusp; RCC = right coronary cusp.
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Figure 2 Tomographic and Angiographic Imaging of the Aortic Root
This figure illustrates the different imaging approaches of (left) tomographic modalities (cross-sectional images of the valve plane) and (right) angiography (orthogonal projection of the aortic root).
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Figure 3 Computed Tomography Images in Specified Angiographic Projections
Reformation of computed tomography images, corresponding to the angiographic left anterior oblique (LAO) and right anterior oblique (RAO) projections. The upper right panel in each half corresponds to the final root angiogram in the LAO and RAO projection. The value for the LAO/RAO and cranial/caudal projection is displayed on the screen.
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Figure 4 Diameter Measurements in the Aortic Root
Standard diameter measurements in the aortic root. (A) A sagittal section of the root and the level of the annulus, sinus of Valsalva, and sinotubular junction (STJ) are shown. (B) Measurements in cross-sectional images at the sinus of Valsalva (upper right) and annulus (lower right) are demonstrated. A cross-section just above the annulus with parts of the 3 leaflets is shown (lower left).
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Figure 5 Corresponding Angiographic Computed Tomography Images
Examples of corresponding X-ray angiographic and multidetector row computed tomography images of the aortic root in the LAO and RAO projections. Abbreviations as in Figure 3.
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Figure 6 Identification of Projections Achievable in the Catheterization Laboratory
In this patient, the LAO 40 angulation is associated with a very steep cranial angulation (cranial 50), which would be impractical in the catheterization laboratory. Additional multidetector row computed tomography planes at different LAO angulations showed a more appropriate shallow cranial angulation (e.g., cranial 14 at an LAO 3 angulation). CRAN/CAUD = cranial/caudal; MPR = multiplanar reconstruction; other abbreviations as in Figure 3.
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