Author + information
- Received June 12, 2009
- Revision received September 28, 2009
- Accepted October 15, 2009
- Published online January 1, 2010.
- Vikram Kurra, MD⁎,†,
- Samir R. Kapadia, MD⁎,
- E. Murat Tuzcu, MD⁎,
- Sandra S. Halliburton, PhD⁎,†,
- Lars Svensson, MD⁎,
- Eric E. Roselli, MD⁎ and
- Paul Schoenhagen, MD⁎,†,⁎ ()
- ↵⁎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
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.
- multidetector computed tomography
- transcatheter aortic valve implantation
- aortic stenosis
- aortic valve
Drs. Tuzcu and Svensson serve on the scientific advisory board for Edwards Life Sciences, Percutaneous Aortic Valve Clinical Trials, without any financial remuneration. Dr. Halliburton receives research support from Siemens Medical Solutions. Dr. Roselli serves as consultant on the transcatheter valve advisory board for Medtronic and is a coinvestigator and consultant for Edwards Life Sciences and a consultant to Direct Flow Medical.
- Received June 12, 2009.
- Revision received September 28, 2009.
- Accepted October 15, 2009.
- American College of Cardiology Foundation