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

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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.

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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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Authors and Affiliations

  1. Institute of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland

    Paul Stolzmann, Lotus Desbiolles, Hans Scheffel, Sebastian Leschka, Borut Marincek & Hatem Alkadhi

  2. Laboratory of Thermodynamics in Emerging Technologies, Department of Mechanical and Process Engineering, ETH Zurich, Switzerland

    Joseph Knight, Vartan Kurtcuoglu & Dimos Poulikakos

  3. Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland

    Willibald Maier

  4. Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland

    André Plass

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  1. Paul Stolzmann
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  2. Joseph Knight
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Correspondence to Hatem Alkadhi.

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Stolzmann, P., Knight, J., Desbiolles, L. et al. Remodelling of the aortic root in severe tricuspid aortic stenosis: implications for transcatheter aortic valve implantation. Eur Radiol 19, 1316–1323 (2009). https://doi.org/10.1007/s00330-009-1302-0

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