Download 2 - JACC: Cardiovascular Interventions

JACC: CARDIOVASCULAR INTERVENTIONS
VOL. 8, NO. 2, 2015
ª 2015 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION
ISSN 1936-8798/$36.00
PUBLISHED BY ELSEVIER INC.
Letter
TO THE EDITOR
image acquisition was performed during an inspiratory breath hold, while the electrocardiogram
was recorded simultaneously to allow retrospective
Valve Sizing for Pure
Aortic Regurgitation
During Transcatheter
Aortic Valve Replacement
Deformation Dynamic of the Aortic Annulus
in Different Valve Pathology May Be Different
gating of the data. The 3-dimensional dataset of
the contrast-enhanced scan was reconstructed in
10% increments over the cardiac cycle, generating
4-dimensional computed tomography data for assessment of the dynamic motion of the aortic valve
annulus. Our results revealed a potentially dramatic
change in the geometric morphology of the aortic
valve annulus (the basal ring) during the cardiac
cycle (Figure 1). In some cases, the aortic valve annulus
even became irregularly shaped during the diastolic
We read with great interest the report by Seiffert et al.
phase (Figure 2). The underlying reasons for this
(1) on the initial German experience with transapical
unique phenomenon may be the pliability of a non-
implantation of a second-generation transcatheter
calcified aortic valve, senile fibroelastic degeneration
heart valve for the treatment of aortic regurgitation.
of the aortic annulus, and the Venturi effect caused
With the development of second-generation trans-
by regurgitation jet flow. Although these results still
catheter aortic value replacement (TAVR) devices,
need further validation, caution should be used in
TAVR indications have been expended to high-risk
annular sizing in patients with pure aortic regurgita-
patients with pure aortic regurgitation. We are par-
tion undergoing TAVR. Deformation dynamics of the
ticularly interested in the measurement of the aortic
aortic valve annulus in different valve pathologies
annular size in patients with pure aortic regurgita-
may be very different.
tion. However, the measurement method was not
detailed in this paper. It is well known that accurate
assessment of the aortic annulus anatomy including
its size and shape is of paramount importance in
TAVR to avoid complications such as device dislodgment, paravalvular leakage, and annular rupture. In
addition, with regard to this unique beating heart
procedure, assessing the dynamic aspects of aortic
annular functional anatomy, such as potential timedependent changes throughout the cardiac cycle,
may be particularly important (2). Recent evidence
confirmed a dynamic motion of the aortic annulus
Da Zhu, MD
Wei Chen, MD
Liqing Peng, MD
*Yingqiang Guo, MD
*Department of Cardiovascular Surgery
West China Hospital
Chengdu
Sichuan
Peoples Republic of China 610041
E-mail: [email protected]
http://dx.doi.org/10.1016/j.jcin.2014.11.011
during the cardiac cycle in both normal and stenotic
aortic valves (2,3). With regard to patients with
REFERENCES
calcified aortic stenosis undergoing TAVR, these
1. Seiffert M, Bader R, Kappert U, et al. Initial German experience with
changes are almost negligible because tissue properties allow very little expansion (2). However, the
deformation dynamics of the aortic annulus may be
dramatically different in patients with noncalcified
aortic regurgitation.
At our institution, 6 high-risk patients with severe
pure aortic regurgitation underwent TAVR using
transapical implantation of a second-generation transcatheter heart valve
for the treatment of aortic regurgitation. J Am Coll Cardiol Intv 2014;7:
1168–74.
2. Hamdan A, Guetta V, Konen E, et al. Deformation dynamics and mechanical
properties of the aortic annulus by 4-dimensional computed tomography:
insights into the functional anatomy of the aortic valve complex and
implications for transcatheter aortic valve therapy. J Am Coll Cardiol 2012;59:
119–27.
another type of second-generation TAVR device. Dur-
3. Peng LQ, Yang ZG, Shao H, et al. Dynamic assessment of normal aortic
valve throughout the cardiac cycle with dual-source computed tomography.
ing preoperative computed tomography angiography,
Int J Cardiol 2011;151:358–60.
JACC: CARDIOVASCULAR INTERVENTIONS VOL. 8, NO. 2, 2015
Letter to the Editor
FEBRUARY 2015:372–3
F I G U R E 1 Variation in Aortic Annulus Dimensions (Basal Ring) Between Mid-Diastolic and Mid-Systolic Phase
The data are from 6 high-risk patients with severe aortic regurgitation (mean age, 74 years of age). Marked differences were noted between 2
phases for long-diameter, short-diameter, cross-sectional area as well as the perimeter, indicating a potentially dramatic change in aortic valve
annulus geometry during the cardiac cycle. Min (D) ¼ minimal value, mid-diastolic phase; Max (S) ¼ maximum value, mid-systolic phase.
F I G U R E 2 Computed Tomography Angiogram Image of Aortic Valve Annulus in Mid-Diastolic and Mid-Systolic Phases
Computed tomography angiogram of the aortic valve annulus (dotted lines indicates basal ring) in the mid-diastolic and mid-systolic phases of
2 patients with severe regurgitation. The dramatic change in aortic valve annulus geometric morphology could be clearly identified. The shape
of the aortic valve annulus even becomes irregular during the diastolic phase.
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