Skip to main content

Advertisement

SpringerLink
Log in

Cardiovascular magnetic resonance as a reliable alternative to cardiovascular computed tomography and transesophageal echocardiography for aortic annulus valve sizing

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

To assess the accuracy and reproducibly of cardiovascular magnetic resonance (CMR) in the measurement of the aortic annulus and in process of valve sizing as compared to intra-operative sizing, cardiovascular computed tomography (CCT) and transesophageal echocardiography (TEE). Retrospective study on 42 patients who underwent aortic valve replacement from September 2010 to September 2015, with available records of pre surgery annulus assessment by CMR, CCT and TEE and of peri-operative assessment. In CCT and CMR, the annular plane was considered a virtual ring formed by the lowest hinge points of the valvular attachments to the aorta. In TEE the annulus was measured at the base of leaflet insertion in the mid-esophageal long-axis view using the X-plane technique. Two double-blinded operators performed the assessments for each imaging technique. Intra-operative evaluation was performed using Hegar dilators. Continuous variables were studied with within-subject ANOVA, Bland–Altman (BA) plots, Wilcoxon’s and Friedman’s tests; trends were explored with scatter plots. Categorical variables were studied with Fisher’s exact test. The intra- and inter-operator reliability was satisfying. There were no significant differences between the annulus dimensions measured by CMR and either one of the three references. Valve sizing for CoreValve by CMR had the same good agreement with CCT and TEE, with a 78 % match rate; for SAPIEN XT the agreement was slightly better (82 %) for CCT than for TEE (66 %). MR performs well when compared to the surgical reference of intra-operative sizing and stands up to the level of the most used imaging references (CCT and TEE).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M (2006) Burden of valvular heart diseases: a population-based study. Lancet 368(9540):1005–1011

    Article  PubMed  Google Scholar 

  2. Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG et al (2010) Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 363(17):1597–1607

    Article  CAS  PubMed  Google Scholar 

  3. Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG et al (2011) Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med 364(23):2187–2198

    Article  CAS  PubMed  Google Scholar 

  4. Zaman S, Gooley R, McCormick L, Harper R, Meredith IT (2015) Pre-transcatheter aortic valve implantation workup in the cardiac catheterisation laboratory. Heart Lung Circ 24(12):1162–1170

    Article  PubMed  Google Scholar 

  5. Tay ELW, Gurvitch R, Wijeysinghe N, Nietlispach F, Leipsic J, Wood DA et al (2011) Outcome of patients after transcatheter aortic valve embolization. J Am Coll Cardiol Cardiovasc Interv 4(2):228–234

    Article  Google Scholar 

  6. Pasic M, Unbehaun A, Dreysse S, Buz S, Drews T, Kukucka M et al (2012) Rupture of the device landing zone during transcatheter aortic valve implantation: a life-threatening but treatable complication. Circ Cardiovasc Interv 5(3):424–432

    Article  PubMed  Google Scholar 

  7. Salizzoni S, Marra WG, Moretti C, D’Amico M, La Torre MW, Rinaldi M (2014) An iatrogenic atrioventricular septal defect that developed following transfemoral TAVI. J Heart Valve Dis 23(2):216–218

    PubMed  Google Scholar 

  8. Kodali SK, Williams MR, Smith CR, Svensson LG, Webb JG, Makkar RR et al (2012) Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med 366(18):1686–1695

    Article  CAS  PubMed  Google Scholar 

  9. Jabbour A, Ismail TF, Moat N, Gulati A, Roussin I, Alpendurada F et al (2011) Multimodality imaging in transcatheter aortic valve implantation and post-procedural aortic regurgitation: comparison among cardiovascular magnetic resonance, cardiac computed tomography, and echocardiography. J Am Coll Cardiol 58(21):2165–2173

    Article  PubMed  Google Scholar 

  10. D’Onofrio A, Salizzoni S, Agrifoglio M, Cota L, Luzi G, Tartara PM et al (2013) Medium term outcomes of transapical aortic valve implantation: results from the Italian registry of trans-apical aortic valve implantation. Ann Thorac Surg 96(3):830–835; discussion 836

    Article  PubMed  Google Scholar 

  11. Jayasuriya C, Moss RR, Munt B (2011) Transcatheter aortic valve implantation in aortic stenosis: the role of echocardiography. J Am Soc Echocardiogr 24(1):15–27

    Article  PubMed  Google Scholar 

  12. Dashkevich A, Blanke P, Siepe M, Pache G, Langer M, Schlensak C et al (2011) Preoperative assessment of aortic annulus dimensions: comparison of noninvasive and intraoperative measurement. Ann Thorac Surg 91(3):709–714

    Article  PubMed  Google Scholar 

  13. Kempfert J, Van Linden A, Lehmkuhl L, Rastan AJ, Holzhey D, Blumenstein J et al (2012) Aortic annulus sizing: echocardiographic vs. computed tomography derived measurements in comparison with direct surgical sizing. Eur J Cardiothorac Surg 42(4):627–633

    Article  PubMed  Google Scholar 

  14. Yano M, Nakamura K, Nagahama H, Matsuyama M, Nishimura M, Onitsuka T (2012) Aortic annulus diameter measurement: what is the best modality? Ann Thorac Cardiovasc Surg 18(2):115–120

    Article  PubMed  Google Scholar 

  15. Bazeed MF, Rezk AI, Moselhy MS (2013) Value of cardiac CT in comprehensive aortic valve and root evaluation before percutaneous aortic valve replacement. Acta Radiol 54(5):498–504

    Article  PubMed  Google Scholar 

  16. Wang H, Hanna JM, Ganapathi A, Keenan JE, Hurwitz LM, Vavalle JP et al (2015) Comparison of aortic annulus size by transesophageal echocardiography and computed tomography angiography with direct surgical measurement. Am J Cardiol 115(11):1568–1573

    Article  PubMed  Google Scholar 

  17. Tsuneyoshi H, Komiya T, Shimamoto T (2016) Accuracy of aortic annulus diameter measurement: comparison of multi-detector CT, two- and three-dimensional echocardiography. J Card Surg 31(1):18–22

    Article  PubMed  Google Scholar 

  18. Pontone G, Andreini D, Bartorelli AL, Bertella E, Mushtaq S, Gripari P et al (2013) Comparison of accuracy of aortic root annulus assessment with cardiac magnetic resonance versus echocardiography and multidetector computed tomography in patients referred for transcatheter aortic valve implantation. Am J Cardiol 112(11):1790–1799

    Article  PubMed  Google Scholar 

  19. Gargiulo G, Capodanno D, Sannino A, Perrino C, Capranzano P, Stabile E et al (2015) Moderate and severe preoperative chronic kidney disease worsen clinical outcomes after transcatheter aortic valve implantation: meta-analysis of 4992 patients. Circ Cardiovasc Interv 8(2):e002220

    Article  PubMed  Google Scholar 

  20. D’Ascenzo F, Moretti C, Salizzoni S, Bollati M, D’Amico M, Ballocca F et al (2013) 30 days and midterm outcomes of patients undergoing percutaneous replacement of aortic valve according to their renal function: a multicenter study. Int J Cardiol 167(4):1514–1518

    Article  PubMed  Google Scholar 

  21. La Manna A, Sanfilippo A, Capodanno D, Salemi A, Polizzi G, Deste W et al (2011) Cardiovascular magnetic resonance for the assessment of patients undergoing transcatheter aortic valve implantation: a pilot study. J Cardiovasc Magn Reson 13:82

    Article  PubMed  PubMed Central  Google Scholar 

  22. Paelinck BP, Van Herck PL, Rodrigus I, Claeys MJ, Laborde J-C, Parizel PM et al (2011) Comparison of magnetic resonance imaging of aortic valve stenosis and aortic root to multimodality imaging for selection of transcatheter aortic valve implantation candidates. Am J Cardiol 108(1):92–98

    Article  PubMed  Google Scholar 

  23. Koos R, Altiok E, Mahnken AH, Neizel M, Dohmen G, Marx N et al (2012) Evaluation of aortic root for definition of prosthesis size by magnetic resonance imaging and cardiac computed tomography: implications for transcatheter aortic valve implantation. Int J Cardiol. 158(3):353–358

    Article  PubMed  Google Scholar 

  24. Ruile P, Blanke P, Krauss T, Dorfs S, Jung B, Jander N et al (2015) Pre-procedural assessment of aortic annulus dimensions for transcatheter aortic valve replacement: comparison of a non-contrast 3D MRA protocol with contrast-enhanced cardiac dual-source CT angiography. Eur Heart J Cardiovasc Imaging [Epub ahead of print]

  25. Bernhardt P, Rodewald C, Seeger J, Gonska B, Buckert D, Radermacher M et al. (2015) Non-contrast-enhanced magnetic resonance angiography is equal to contrast-enhanced multislice computed tomography for correct aortic sizing before transcatheter aortic valve implantation. Clin Res Cardiol 105(3):273–278

    Article  PubMed  Google Scholar 

  26. Smíd M, Ferda J, Baxa J, Cech J, Hájek T, Kreuzberg B et al (2010) Aortic annulus and ascending aorta: comparison of preoperative and periooperative measurement in patients with aortic stenosis. Eur J Radiol 74(1):152–155

    Article  PubMed  Google Scholar 

  27. Piazza N, de Jaegere P, Schultz C, Becker AE, Serruys PW, Anderson RH (2008) Anatomy of the aortic valvar complex and its implications for transcatheter implantation of the aortic valve. Circ Cardiovasc Interv 1(1):74–81

    Article  PubMed  Google Scholar 

  28. Kasel AM, Cassese S, Bleiziffer S, Amaki M, Hahn RT, Kastrati A et al (2013) Standardized imaging for aortic annular sizing: implications for transcatheter valve selection. J Am Coll Cardiol Cardiovasc Imaging 6(2):249–262

    Article  Google Scholar 

  29. Potthast S, Mitsumori L, Stanescu LA, Richardson ML, Branch K, Dubinsky TJ et al (2010) Measuring aortic diameter with different MR techniques: comparison of three-dimensional (3D) navigated steady-state free-precession (SSFP), 3D contrast-enhanced magnetic resonance angiography (CE-MRA), 2D T2 black blood, and 2D cine SSFP. J Magn Reson Imaging 31(1):177–184

    Article  PubMed  Google Scholar 

  30. Suchá D, Tuncay V, Prakken NHJ, Leiner T, van Ooijen PMA, Oudkerk M et al (2015) Does the aortic annulus undergo conformational change throughout the cardiac cycle? A systematic review. Eur Heart J Cardiovasc Imaging 16(12):1307–1317

    PubMed  Google Scholar 

  31. Leber AW, Eichinger W, Rieber J, Lieber M, Schleger S, Ebersberger U et al (2013) MSCT guided sizing of the Edwards Sapien XT TAVI device: impact of different degrees of oversizing on clinical outcome. Int J Cardiol 168(3):2658–2664

    Article  CAS  PubMed  Google Scholar 

  32. Karambatsakidou A, Omar A, Chehrazi B, Rück A, Scherp Nilsson J, Fransson A (2016) Skin dose, effective dose and related risk in transcatheter aortic valve implantation (tavi) procedures: is the cancer risk acceptable for younger patients? Radiat Prot Dosimetry [Epub ahead of print]

  33. Wong S, Spina R, Toemoe S, Dhital K (2016) Is cardiac magnetic resonance imaging as accurate as echocardiography in the assessment of aortic valve stenosis? Interact Cardiovasc Thorac Surg 22(4):480–486

    Article  PubMed  Google Scholar 

  34. Flett AS, Sado DM, Quarta G, Mirabel M, Pellerin D, Herrey AS et al (2012) Diffuse myocardial fibrosis in severe aortic stenosis: an equilibrium contrast cardiovascular magnetic resonance study. Eur Heart J Cardiovasc Imaging 13(10):819–826

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We acknowledge the collaboration and support of Gaita F., Gandini G., Davini O., Righi D., Attisani M., Berzovini C., Capriolo M., Comoglio C., Frea S., Marchetto G., Marchisio F., Rusciano A., Salmè G. and Secinaro A.

Author information

Authors and Affiliations

  1. Department of Surgical Sciences, Radiology Institute, University of Turin, Via Genova 3, 10126, Turin, Italy

    Riccardo Faletti, Marco Gatti & Paolo Fonio

  2. Division of Cardiac Surgery, Department of Surgical Sciences, University of Turin, Turin, Italy

    Stefano Salizzoni, Michele La Torre & Mauro Rinaldi

  3. Department of Surgical Sciences, University of Turin, Turin, Italy

    Laura Bergamasco & Rodolfo Bonamini

  4. Department of Radiodiagnostic, S.C. Radiodiagnostica Ospedaliera, Turin, Italy

    Domenica Garabello & Simona Veglia

  5. Division of Cardiology, Department of Medical Sciences,, University of Turin, Turin, Italy

    Walter Grosso Marra & Mara Morello

Authors
  1. Riccardo Faletti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marco Gatti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stefano Salizzoni
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Laura Bergamasco
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rodolfo Bonamini
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Domenica Garabello
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Walter Grosso Marra
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Michele La Torre
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Mara Morello
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Simona Veglia
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Paolo Fonio
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Mauro Rinaldi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Riccardo Faletti.

Ethics declarations

Conflict of interest

All authors declare that they have no conflicts.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Faletti, R., Gatti, M., Salizzoni, S. et al. Cardiovascular magnetic resonance as a reliable alternative to cardiovascular computed tomography and transesophageal echocardiography for aortic annulus valve sizing. Int J Cardiovasc Imaging 32, 1255–1263 (2016). https://doi.org/10.1007/s10554-016-0899-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-016-0899-8

Keywords

Search

Navigation