European Radiology

, Volume 19, Issue 6, pp 1316–1323 | Cite as

Remodelling of the aortic root in severe tricuspid aortic stenosis: implications for transcatheter aortic valve implantation

  • Paul Stolzmann
  • Joseph Knight
  • Lotus Desbiolles
  • Willibald Maier
  • Hans Scheffel
  • André Plass
  • Vartan Kurtcuoglu
  • Sebastian Leschka
  • Dimos Poulikakos
  • Borut Marincek
  • Hatem Alkadhi
Cardiac

Abstract

Detailed knowledge of aortic root geometry is a prerequisite to anticipate complications of transcatheter aortic valve (TAV) implantation. We determined coronary ostial locations and aortic root dimensions in patients with aortic stenosis (AS) and compared these values with normal subjects using computed tomography (CT). One hundred consecutive patients with severe tricuspid AS and 100 consecutive patients without valvular pathology (referred to as the controls) undergoing cardiac dual-source CT were included. Distances from the aortic annulus (AA) to the left coronary ostium (LCO), right coronary ostium (RCO), the height of the left coronary sinus (HLS), right coronary sinus (HRS), and aortic root dimensions [diameters of AA, sinus of Valsalva (SV), and sino-tubular junction(STJ)] were measured. LCO and RCO were 14.9 ± 3.2 mm (8.2–25.9) and 16.8 ± 3.6 mm (12.0–25.7) in the controls, 15.5 ± 2.9 mm (8.8–24.3) and 17.3 ± 3.6 mm (7.3–26.0) in patients with AS. Controls and patients with AS had similar values for LCO (P = 0.18), RCO (P = 0.33) and HLS (P = 0.88), whereas HRS (P < 0.05) was significantly larger in patients with AS. AA (r = 0.55,P < 0.001), SV (r = 0.54,P < 0.001), and STJ (r = 0.52,P < 0.001) significantly correlated with the body surface area in the controls; whereas no correlation was found in patients with AS. Patients with AS had significantly larger AA (P < 0.01) and STJ (P < 0.01) diameters when compared with the controls. In patients with severe tricuspid AS, coronary ostial locations were similar to the controls, but a transverse remodelling of the aortic root was recognized. Owing to the large distribution of ostial locations and the dilatation of the aortic root, CT is recommended before TAV implantation in each patient.

Keywords

Aortic stenosis CT coronary angiography Transcatheter aortic valves Aortic root geometry 

Notes

Acknowledgements

This study was supported by the National Center of Competence in Research, Computer Aided and Image Guided Medical Interventions of the Swiss National Science Foundation.

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Copyright information

© European Society of Radiology 2009

Authors and Affiliations

  • Paul Stolzmann
    • 1
  • Joseph Knight
    • 2
  • Lotus Desbiolles
    • 1
  • Willibald Maier
    • 3
  • Hans Scheffel
    • 1
  • André Plass
    • 4
  • Vartan Kurtcuoglu
    • 2
  • Sebastian Leschka
    • 1
  • Dimos Poulikakos
    • 2
  • Borut Marincek
    • 1
  • Hatem Alkadhi
    • 1
  1. 1.Institute of Diagnostic RadiologyUniversity Hospital ZurichZurichSwitzerland
  2. 2.Laboratory of Thermodynamics in Emerging Technologies, Department of Mechanical and Process EngineeringETH ZurichSwitzerland
  3. 3.Cardiovascular CenterUniversity Hospital ZurichZurichSwitzerland
  4. 4.Clinic for Cardiovascular SurgeryUniversity Hospital ZurichZurichSwitzerland

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