Gianluca Pontone MD, Presenter: Nothing to Disclose

Daniele Andreini MD, Abstract Co-Author: Nothing to Disclose

Antonio Bartorelli, Abstract Co-Author: Nothing to Disclose

Andrea Daniele Annoni MD, Abstract Co-Author: Nothing to Disclose

Saima Mushtaq, Abstract Co-Author: Nothing to Disclose

Erika Bertella, Abstract Co-Author: Nothing to Disclose

Melissa Fusari MD, Abstract Co-Author: Nothing to Disclose

Giovanni Ballerini, Abstract Co-Author: Nothing to Disclose

Cesare Fiorentini MD, Abstract Co-Author: Nothing to Disclose

Mauro Pepi, Abstract Co-Author: Nothing to Disclose

Aim of this study is to identify anatomical predictors of AoI evaluated by MDCT.

Sixty patients (Male 22, age 80±8 yo) with severe aortic stenosis (Area:0.7±0.2 cm2) referred for TAVI were included in our study. In all patients transesophageal echocardiography (TEE) and MDCT were performed before TAVI. The following parameters were evaluated: AoA diameter by TEE (AoA-DTEE), maximum diameter (Max-AoA-DMDCT), minimum diameter (Min-AoA-DMDCT) and area (AoA-AMDCT) of AoA defined as a virtual ring formed by joining the basal attachments of the aortic leaflets; lumen morphology index (LMI) defined as Max-AoA-DMDCT/Min-AoA-DMDCT ratio; AoAMDCT /Prosthesis mismatch defined as the difference between the AoA-AMDCT and the area of the valve prosthesis implanted.; aortic leaflet calcifications (ALC) assessed on a short axis view and graded visually (score 1 to 4). The final choice of prosthesis size was based on AoA-DTEE. After TAVI, the AoI was graded as none, mild (grade 1), mild to moderate (grade 2), moderate (grade 3) or severe (grade 4) by TEE. Spearman’s correlation and Bland-Altman analysis were used to compare MDCT vs. TEE. The differences between patients with AoI post-TAVI > or = 2 versus patients with AoI post-TAVI<2 were tested using Student t test for unpaired data.

Max-AoA-DMDCT, Min-AoA-DMDCT, AoA-AMDCT and LMI were 25.1±2.8 mm, 21.2±2.2 mm, 410.5±81.4 mm2 and 1.19±0.1, respectively. The mean ALC was 3.3±0.5. The Spearman’s correlation and Bland-Altman analysis between Max-AoA-DMDCT and Min-AoA-DMDCT vs. AoA-DTEE were 0.82 (p<0.001) , 0.88 (p<0.001), 4.1±2.3 mm and 0.3±1.7 mm, respectively. After the procedure, TTE showed absence of AoI in 10 (23%) patients, mild in 26 (61%) patients, mild-to-moderate in 5 (13%) patients, and moderate-to-severe in 1 (3%) patient. Patients with AoI≥ grade 2 in comparison with patients with AoI<2 showed higher LMI (p<0.05), ALC score (p<0.05) and systolic AoA-AMDCT/Prosthesis mismatch (p<0.001).

Before TAVI, assessment of AoA by MDCT may provide useful information for the selection of patients and prosthesis size.

The evaluation of aortic valve anatomy with MDCT could improve post-operatory outcomes.

Pontone, G, Andreini, D, Bartorelli, A, Annoni, A, Mushtaq, S, Bertella, E, Fusari, M, Ballerini, G, Fiorentini, C, Pepi, M, Anatomical Predictors of Paravalvular Aortic Regurgitation (AoI) after Transcatheter Aortic Valve Implantation (TAVI) Detected by Multidetetctor Computed Tomography (MDCT).  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11012133.html