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In Vivo Imaging and Computational Analysis of the Aortic Root. Application in Clinical Research and Design of Transcatheter Aortic Valve Systems

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Abstract

Valvular heart disease is a major cause of morbidity and mortality in developing and industrialized countries. For patients with advanced symptomatic disease, surgical open-heart valve replacement is an effective treatment, supported by long-term outcome data. More recently, less-invasive transcatheter approaches for valve replacement/implantation have been developed for patients that are not considered surgical candidates. An understanding of valvular and paravalvular anatomy and biomechanics is pivotal for the optimization of interventional valve procedures. Advanced imaging is increasingly used not only for clinical guidance but also for the design and further improvement of transcatheter valve systems. Computed tomography is particularly attractive because it acquires high-resolution volumetric data sets of the root including the leaflets and coronary artery ostia, with sufficient temporal resolution for multi-phasic analysis. These volumetric data sets allow subsequent 3-D and 4-D display, reconstruction in unlimited planes, and mathematical modeling. Computer modeling, specifically finite element analysis, of devices intended for implantation in the aortic root, allows for structural analysis of devices and modeling of the interaction between the device and cardiovascular anatomy. This paper will provide an overview of computer modeling of the aortic root and describe FEA approaches that could be applied to TAVI and have an impact on clinical practice and device design.

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Abbreviations

AS:

Aortic stenosis

AVA:

Aortic valve area

AVR:

Aortic valve replacement

CT:

Computed tomography

FEA:

Finite element analysis

MDCT:

Multi-detector computed tomography

MRI:

Magnetic resonance imaging

TAV:

Transcatheter aortic valve

TAVI:

Transcatheter aortic valve implantation

STJ:

Sinotubular junction

2-D:

Two-dimensional

3-D:

Three-dimensional

3-D Echo:

Three-dimensional echocardiography

4-D:

Four-dimensional

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Acknowledgments

The authors would like to thank Mike Schendel (Medtronic, Inc.) for his assistance on this manuscript.

Financial Disclosure

Paul Schoenhagen, Zoran Popovic, and Sandra S. Halliburton have no disclosures. Alexander Hill and Tim Kelley are employees of Medtronic, Inc.

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Authors and Affiliations

  1. Imaging Institute and Heart & Vascular Institute, The Cleveland Clinic, Desk J-1 4, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Paul Schoenhagen, Zoran Popovic & Sandra S. Halliburton

  2. CardioVascular, Structural Heart Disease, Medtronic, Inc, Minneapolis, MN, USA

    Alexander Hill & Tim Kelley

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  1. Paul Schoenhagen
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  2. Alexander Hill
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  3. Tim Kelley
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Correspondence to Paul Schoenhagen.

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Schoenhagen, P., Hill, A., Kelley, T. et al. In Vivo Imaging and Computational Analysis of the Aortic Root. Application in Clinical Research and Design of Transcatheter Aortic Valve Systems. J. of Cardiovasc. Trans. Res. 4, 459–469 (2011). https://doi.org/10.1007/s12265-011-9277-z

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