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Title: [Comparison of aortic annular diameter defined by different measurement mordalities before transcatheter aortic valve implantation].
Author: Qi RX, You XD, Pu ZX, Yang Q, Huang ZX, Zhou LM, Huang PT.
Journal: Zhonghua Xin Xue Guan Bing Za Zhi; 2017 May 24; 45(5):409-414. PubMed ID: 28511326.
Abstract:
Objective: To compare aortic annular diameter measured by transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and multislice computed tomography (MSCT) in patients with severe aortic stenosis, and to evaluate the impact on selection of prosthetic valve type in transcatheter aortic valve implantation (TAVI). Methods: Clinical data of 138 patients with severe aortic stenosis referred for TAVI between January 2014 and June 2016 in our hospital were retrospectively analyzed.The difference of aortic annular diameter measured by TTE, TEE, and MSCT were compared.TTE was performed after TAVI to evaluate the accuracy of measurement before TAVI. Results: (1) Aortic annular diameter was (23.37±2.22) mm by TTE and (23.52±1.70) mm by TEE (P=0.12). Pearson correlation analysis showed that aortic annular diameter measured by TTE was correlated to that measured by TEE (r=0.87, P<0.05). (2)The long-axis diameter and the short-axis diameter measured by MSCT multiplanar reconstruction were significantly different ((27.86±2.87) mm vs. (21.91±2.53) mm, P<0.05). There was no significant difference between the mean of the long- and short-axis diameters and the diameter derived from cross-sectional area by MSCT ((24.92±2.38) mm vs. (24.84±2.25) mm, P=0.08). However, the diameter derived from the circumference ((25.35±2.34) mm) was significantly larger than the mean of the long- and short-axis diameters and the diameter derived from cross-sectional area by MSCT, and the difference were (0.43±0.62) mm and (0.51±0.62) mm respectively(both P<0.05). (3) Measurements of the aortic annulus diameter by MSCT including the mean of the long- and short-axis diameters, diameter derived from cross-sectional area, and diameter derived from the circumference were larger than the measurement by TTE and TTE (all P<0.05). (4) Implantation was successful in all patients.Moderate to severe paravalvular leakage was detected in 3 patients at 7 days post TAVI, and 1 patient developed severe prosthetic valve restenosis at 6 months post TAVI and received valve-in-valve implantation. Conclusions: In severe aortic stenosis patients referred for TAVI, the aortic annular diameter derived from TTE and TEE measurements are smaller than that from MSCT.In the absence of a gold standard, selection of prosthetic valve type in TAVI procedure should rely on comprehensive considerations, which is of importance to get good clinical results for severe aortic stenosis patients underwent TAVI. 目的： 比较经胸超声心动图(TTE)、经食管超声心动图(TEE)和多排螺旋CT(MSCT)测量的重度主动脉瓣狭窄患者主动脉瓣环内径的差异，并评估检查结果对经导管主动脉瓣置换术(TAVI)中人工瓣膜型号选择的影响。 方法： 回顾性分析2014年1月至2016年6月期间在浙江大学医学院附属第二医院行TAVI的138例重度主动脉狭窄患者的临床资料，比较TTE、TEE和MSCT 3种检查方法测量主动脉瓣环内径的差异。术后复查TTE，评估术前主动脉瓣环内径测量的准确性。 结果： (1)TTE测量的主动脉瓣环内径为(23.37±2.22) mm，TEE测量的主动脉瓣环内径为(23.52±1.70) mm，两者差异无统计学意义(P＝0.12)。Pearson相关分析显示，TTE与TEE测量的主动脉瓣环内径有相关性(r＝0.87，P<0.05)。(2)MSCT测量的主动脉瓣环长径与短径差异有统计学意义[(27.86±2.87) mm比(21.91±2.53) mm，P<0.05]；MSCT测量的主动脉瓣环算术平均径与面积平均径差异无统计学意义[(24.92±2.38) mm比(24.84±2.25) mm，P＝0.08]；MSCT测量的主动脉瓣环周长平均径[(25.35±2.34) mm]均大于算术平均径和面积平均径，差值分别为(0.43±0.62) mm和(0.51±0.62) mm(P均<0.05)。(3)MSCT测量的主动脉瓣环算术平均径、面积平均径和周长平均径均大于TTE和TEE测量的主动脉瓣环内径(P均<0.05)。(4)术后第7天，3例患者出现中等量以上瓣周漏；术后6个月，1例患者出现人工瓣膜再狭窄，并行经导管瓣中瓣置入术。 结论： TTE和TEE测量主动脉瓣环内径比MSCT的测量值小。在目前缺乏理想测量方法的情况下，综合多种影像结果可更好地指导TAVI术中人工瓣膜型号的选择。.

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