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September, 2013 | Electronics World - Part 10

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Transthoracic and transesophageal echocardiography and contrast aortography have been the most frequently used imaging methods in recent years to determine the size of the aortic annulus and root, as well as assisting in the selection of an appropriate prosthesis. Advances in computed tomography (CT), including an increasing number of detectors and hence better spatial and temporal resolution than previous generations, means multislice CT (MSCT) can provide detailed anatomical information on the aortic annulus, the anatomic relationship of the annulus to the coronary ostia, and the aortic arch. In selected patients, MSCT also provides valuable pre-interventional information on arterial access for delivery of the valve prosthesis. It thus contributes in various ways to the diagnosis and management of severe aortic stenosis.

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In surgical valve repair, non-invasive estimates by the usual methods of transthoracic and transesophageal echocardiography are not entirely reliable for selecting the correct prosthesis size, and dilators are used during the procedure to measure the aortic annulus. Additionally, in surgical replacement accuracy of measurement may be of less importance, since the prosthesis is sewn to adjacent tissues. In TAVI, measurements are made solely by imaging techniques, which are therefore of greater importance. A study of 33 patients undergoing surgical aortic valve replacement showed good agreement between aortic annulus dimensions measured by CT and by direct intraoperative methods. Measurements obtained by MSCT present less inter-observer variability than by transthoracic echocardiography and contrast aortography, but not by transesophageal echocardiography.

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The dimensions of the aortic annulus determine prosthesis size, hence accurate measurement of this parameter is critical in assessing candidates for TAVI to minimize the potential for paravalvular leak and to avoid prosthesis migration. Although a gold standard method of measurement has yet to be established, the joint guidelines of the European Association of Cardio-Thoracic Surgery, the European Society of Cardiology and the European Association of Percutaneous Cardiovascular Interventions state that MSCT and MRI can provide a more accurate assessment of the valve annulus and adjoining structures than two-dimensional transthoracic or transesophageal echocardiography ().

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