Noninvasive Evaluation of the Aortic Root With Multislice Computed Tomography Implications for Transcatheter Aortic Valve Replacement
Noninvasive Evaluation of the Aortic Root With Multislice Computed Tomography Implications for Transcatheter Aortic Valve Replacement
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DOI：
10.1016/j.jcmg.2007.12.006
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发表时间：
2008-05-01
影响因子：
14
通讯作者：
Bax, Jeroen J.
中科院分区：
文献类型：
--
作者：
Tops, Laurens F.;Wood, David A.;Bax, Jeroen J.
目的 在本研究中，通过多层计算机断层扫描 (MSCT) 对主动脉根部的解剖结构进行无创评估。 背景 对于患有严重主动脉瓣狭窄的高危患者，经导管主动脉瓣置换术已被提议作为手术的替代方案。对于该手术，需要详细了解主动脉环直径以及主动脉环与冠状动脉之间的关系。 方法 对 169 名患者（111 名男性，年龄 54 +/- 11 岁）进行 64 层 MSCT 扫描以评估冠状动脉疾病。其中，150 名患者没有或轻度主动脉瓣狭窄，19 名患者有中度至重度主动脉瓣狭窄。重建的冠状面和矢状面视图用于评估两个方向的主动脉环直径。此外，还评估了左右冠状动脉的环带和开口之间的距离以及冠状动脉小叶的长度。舒张末期单斜矢状位图对左室流出道和室间隔进行分析。结果主动脉瓣环直径在冠状位图上为26.3±2.8mm，在矢状位图上为23.5±2.7mm。两个直径之间的平均差为 2.9 +/- 1.8 mm，表明主动脉环呈椭圆形。主动脉环与右冠状动脉口之间的平均距离为17.2 +/- 3.3 mm，主动脉环与左冠状动脉口之间的平均距离为14.4 +/- 2.9 mm。 82 名患者 (49%) 的左冠状动脉瓣叶长度超过左冠状动脉瓣环和开口之间的距离。重度主动脉瓣狭窄患者与非重度主动脉瓣狭窄患者的瓣环直径、Valsalva窦直径、瓣环、左冠状动脉瓣叶和左冠状动脉口之间的距离均无显着性差异。结论MSCT可以提供主动脉瓣环形状以及瓣环与冠状动脉口关系的详细信息。因此，MSCT可能有助于避免瓣周漏和冠状动脉闭塞，并可能有助于选择经导管主动脉瓣置换术的候选者。 （J Am Coll Cardiol Img 2008；1：321-30）(C) 2008 年，美国心脏病学会基金会
OBJECTIVES In the present study, the anatomy of the aortic root was assessed noninvasively with multislice computed tomography (MSCT).BACKGROUND Transcatheter aortic valve replacement has been proposed as an alternative to surgery in high-risk patients with severe aortic stenosis. For this procedure, detailed knowledge of aortic annulus diameters and the relation between the annulus and the coronary arteries is needed.METHODS In 169 patients (111 men, age 54 +/- 11 years), a 64-slice MSCT scan was performed for evaluation of coronary artery disease. Of these, 150 patients had no or mild aortic stenosis, and 19 patients had moderate to severe aortic stenosis. Reconstructed coronal and sagittal views were used for assessment of the aortic annulus diameter in 2 directions. In addition, the distance between the annulus and the ostium of the right and left coronary arteries and the length of the coronary leaflets were assessed. The LV outflow tract and interventricular septum were analyzed on the single oblique sagittal view at end-diastole.RESULTS The diameter of the aortic annulus was 26.3 +/- 2.8 mm on the coronal view, and 23.5 +/- 2.7 mm on the sagittal view. Mean difference between the 2 diameters was 2.9 +/- 1.8 mm, indicating an oval shape of the aortic annulus. Mean distance between the aortic annulus and the ostium of the right coronary artery was 17.2 +/- 3.3 mm, and mean distance between the annulus and the ostium of the left coronary artery was 14.4 +/- 2.9 mm. In 82 patients (49%), the length of the left coronary leaflet exceeded the distance between the annulus and the ostium of the left coronary artery. There were no significant differences in the diameter of annulus, diameter of sinus of Valsalva, or the distance between the annulus, left coronary leaflet, and the ostium of the left coronary artery, between the patient with and without severe aortic stenosis.CONCLUSIONS The MSCT can provide detailed information on the shape of the aortic annulus and the relation between the annulus and the ostia of the coronary arteries. Thereby, MSCT may be helpful for avoiding paravalvular leakage and coronary occlusion and may facilitate the selection of candidates for transcatheter aortic valve replacement. (J Am Coll Cardiol Img 2008; 1: 321-30) (C) 2008 by the American College of Cardiology Foundation