TY - JOUR
T1 - Imaging in patients with severe mitral annular calcification
T2 - Insights from a multicentre experience using transatrial balloon-expandable valve replacement
AU - Praz, Fabien
AU - Khalique, Omar K.
AU - Lee, Raymond
AU - Wu, Isaac Y.
AU - Russell, Hyde
AU - Guerrero, Mayra
AU - Wang, Dee Dee
AU - Veeragandham, Ramesh
AU - Islam, Ashequl M.
AU - Deaton, David W.
AU - Kaneko, Tsuyoshi
AU - Eudailey, Kyle W.
AU - Akkoc, Deniz
AU - Kantor, Alex
AU - Wang, Catherine
AU - Tang, Diane C.H.
AU - Park, Joongheum S.
AU - Leung, Diana
AU - Nazif, Tamim M.
AU - Vahl, Torsten P.
AU - Hahn, Rebecca T.
AU - Kodali, Susheel K.
AU - Leon, Martin B.
AU - Takayama, Hiroo
AU - Bapat, Vinayak
AU - Borger, Michael A.
AU - George, Isaac
N1 - Funding Information:
F.P. was supported by a grant from the Gottfried and Julia Bangerter-Rhyner-Foundation, Bern, Switzerland.
Publisher Copyright:
© 2019 Published on behalf of the European Society of Cardiology. All rights reserved.
PY - 2019/12/1
Y1 - 2019/12/1
N2 - Aims: To investigate valve sizing and the haemodynamic relevance of the predicted left ventricular outflow tract (LVOT) in patients with mitral annular calcification (MAC) undergoing transatrial transcatheter valve implantation (THV). Methods and results: In total, 21 patients undergoing transatrial THV, multiplanar reconstruction (MPR), maximum intensity projection (MIP), and cubic spline interpolation (CSI) were compared for MA sizing during diastole. In addition, predicted neo-LVOT areas were measured in 18 patients and correlated with the post-procedural haemodynamic dimensions. The procedure was successful in all patients (100%). Concomitant aortic valve replacement was performed in eight patients (43%) (AVR group). Sizing using MPR and MIP yielded comparable results in terms of area, perimeter, and diameter, whereas the dimensions obtained with CSI were systematically smaller. The simulated mean systolic neo-LVOT area was 133.4 ± 64.2 mm2 with an anticipated relative LVOT area reduction (neo-LVOT area/LVOT area × 100) of 59.3 ± 14.7%. The systolic relative LVOT area reduction, but not the absolute neo-LVOT area, was found to predict the peak (r = 0.69; P = 0.002) and mean (r = 0.65; P = 0.004) post-operative aortic gradient in the overall population as well as separately in the AVR (peak: r = 0.91; P = 0.002/mean: r = 0.85; P = 0.002) and no-AVR (peak: r = 0.89; P = 0.003/mean: r = 0.72; P = 0.008) groups. Conclusion: In patients with severe MAC undergoing transatrial transcatheter valve implantation, MPR, and MIP yielded comparable annular dimensions, while values obtained with CSI tended to be systematically smaller. Mitral annular area and the average annular diameter appear to be reliable parameters for valve selection. Simulated relative LVOT reduction was found to predict the post-procedural aortic gradients.
AB - Aims: To investigate valve sizing and the haemodynamic relevance of the predicted left ventricular outflow tract (LVOT) in patients with mitral annular calcification (MAC) undergoing transatrial transcatheter valve implantation (THV). Methods and results: In total, 21 patients undergoing transatrial THV, multiplanar reconstruction (MPR), maximum intensity projection (MIP), and cubic spline interpolation (CSI) were compared for MA sizing during diastole. In addition, predicted neo-LVOT areas were measured in 18 patients and correlated with the post-procedural haemodynamic dimensions. The procedure was successful in all patients (100%). Concomitant aortic valve replacement was performed in eight patients (43%) (AVR group). Sizing using MPR and MIP yielded comparable results in terms of area, perimeter, and diameter, whereas the dimensions obtained with CSI were systematically smaller. The simulated mean systolic neo-LVOT area was 133.4 ± 64.2 mm2 with an anticipated relative LVOT area reduction (neo-LVOT area/LVOT area × 100) of 59.3 ± 14.7%. The systolic relative LVOT area reduction, but not the absolute neo-LVOT area, was found to predict the peak (r = 0.69; P = 0.002) and mean (r = 0.65; P = 0.004) post-operative aortic gradient in the overall population as well as separately in the AVR (peak: r = 0.91; P = 0.002/mean: r = 0.85; P = 0.002) and no-AVR (peak: r = 0.89; P = 0.003/mean: r = 0.72; P = 0.008) groups. Conclusion: In patients with severe MAC undergoing transatrial transcatheter valve implantation, MPR, and MIP yielded comparable annular dimensions, while values obtained with CSI tended to be systematically smaller. Mitral annular area and the average annular diameter appear to be reliable parameters for valve selection. Simulated relative LVOT reduction was found to predict the post-procedural aortic gradients.
KW - computed tomography
KW - mitral annular calcification
KW - mitral regurgitation
KW - mitral stenosis
KW - transcatheter mitral valve replacement
KW - valvular heart disease
UR - https://www.scopus.com/pages/publications/85075813227
U2 - 10.1093/ehjci/jez050
DO - 10.1093/ehjci/jez050
M3 - Article
C2 - 31220240
AN - SCOPUS:85075813227
SN - 2047-2404
VL - 20
SP - 1395
EP - 1406
JO - European heart journal cardiovascular Imaging
JF - European heart journal cardiovascular Imaging
IS - 12
ER -