Aortic annulus area assessment by multidetector computed tomography for predicting paravalvular regurgitation in patients undergoing balloon-expandable transcatheter aortic valve implantation: A comparison with transthoracic and transesophageal echocardiography

作者：Pontone Gianluca^*; Andreini Daniele; Bartorelli Antonio L; Bertella Erika; Cortinovis Sarah; Mushtaq Saima; Annoni Andrea; Formenti Alberto; Baggiano Andrea; Conte Edoardo; Tamborini Gloria; Muratori Manuela; Gripari Paola; Bovis Francesca; Veglia Fabrizio; Foti Claudia; Alamanni Francesco; Ballerini Giovanni; Fiorentini Cesare; Pepi Mauro

来源：American Heart Journal, 2012, 164(4): 576-584.

DOI：10.1016/j.ahj.2012.06.024

Background Transcatheter aortic valve implantation (TAVI) is a valid alternative to surgery in high-risk patients with severe aortic stenosis. Aortic annulus (AoA) sizing is crucial for TAVI success. The aim of the study was to compare AoA dimensions measured by multidetector computed tomography (MDCT) vs those obtained with transthoracic (TTE) and transesophageal echocardiography (TEE) for predicting paravalvular aortic regurgitation (PVR) after TAVI. %26lt;br%26gt;Methods Aortic annulus maximum diameter, minimum diameter, and area were assessed using MDCT and compared with TTE and TEE diameter and area for predicting PVR after TAVI in 151 patients (45 men, age 81.2 +/- 6.4 years). %26lt;br%26gt;Results Aortic annulus maximum, minimum diameter, and area detected by MDCT were 25.04 +/- 2.39 mm, 21.27 +/- 2.10 mm, and 420.87 +/- 76.10 mm(2), respectively. Aortic annulus diameter and area measured by TTE and TEE were 21.14 +/- 1.94 mm and 353.82 +/- 64.57 mm(2) and 22.04 +/- 1.94 mm and 384.33 +/- 67.30 mm(2), respectively. A good correlation was found between AoA diameters and area evaluated by MDCT vs TTE and TEE (0.61, 0.65, and 0.69 and 0.61, 0.65, and 0.70, respectively), with a mean difference of 3.90 +/- 1.98 mm, 0.13 +/- 1.67 mm, and 67.05 +/- 55.87 mm(2) and 3.0 +/- 2.0 mm, 0.77 +/- 1.70 mm, and 36.54 +/- 56.43 mm(2), respectively. Grade %26gt;= 2 PVR occurred in 46 patients and was related to male gender, higher body mass index, preprocedural aortic regurgitation, and lower mismatch between the nominal area of the implanted prosthesis and AoA area detected by MDCT. %26lt;br%26gt;Conclusions Mismatch between prosthesis area and AoA area detected by MDCT is a better predictor of PVR as compared with echocardiography mismatch. Specific MDCT-based sizing recommendations should be developed. (Am Heart J 2012;164:576-84.)

• 出版日期2012-10