Rationale and Objectives
The optimal phase for the measurement of the aortic annular area for transcatheter
aortic valve replacement (TAVR) is not standardized, although most agree that systolic
measurements are preferred, when the annulus is larger. We hypothesized that the maximum
annular area occurs at the cardiac phase of the maximum aortic valve opening (MAVO)
and that this phase can be accurately and reproducibly assessed by visual inspection
only.
Materials and Methods
The aortic valve opening area was inspected visually by two readers to determine the
MAVO phase. The annular area was measured at the MAVO phase and the typical systolic
phase (35% of the R-R interval). Differences in the annular area that would change
valve sizing for prostheses were noted.
Results
Fifty patients (mean age 81) were studied. Ninety percent had the MAVO at the 15%–25%
R-R interval. There was high interobserver correlation (0.89) for determining the
MAVO phase by visual inspection. For 49 out of 50 patients, the annular area was maximal
at the MAVO phase. The mean difference in the annular area between the MAVO phase
and 35% was 22.3 (±4.57) mm2. In 12% of the patients, the difference in the annular area changed the recommended
size of a self-expanding prosthesis and would have altered the procedure in 32% for
balloon-expandable prostheses.
Conclusions
Visually assessed MAVO occurs in early systole for most patients and is almost always
the cardiac phase of the maximal aortic annular area. This method allows rapid and
reproducible determination of the appropriate phase for TAVR planning measurements.
Consideration should be given to optimizing pre-TAVR computed tomography acquisitions
for early systolic reconstruction and visual determination of the MAVO.
Key Words
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Article info
Publication history
Published online: May 08, 2017
Accepted:
March 14,
2017
Received in revised form:
February 1,
2017
Received:
July 25,
2016
Footnotes
The institutional review board approved this study.
Identification
Copyright
© 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.