A simplified D-shaped model of the mitral annulus to facilitate CT-based sizing before transcatheter mitral valve implantation |
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| Institution: | 1. Center for Heart Valve Innovation, St. Paul''s Hospital, University of British Columbia, Vancouver, BC, Canada;2. Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA;3. Section of Cardiovascular Radiology, Department of Radiology, University of Freiburg, Freiburg, Germany;1. Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy;2. Centro Cardiologico Monzino IRCCS, Milan, Italy;3. Noninvasive Cardiac Imaging Laboratory, University of Chicago, Chicago, IL, USA;1. St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada;2. Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York;3. Baylor Heart and Vascular Institute, Dallas, Texas and Department of Internal Medicine, the Heart Hospital Baylor Plano, Plano, Texas;4. Division of Cardiology, University of Washington Medical Center, Seattle, Washington;6. Department of Medicine, Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada;1. St. Paul''s Hospital, University of British Columbia, Vancouver, BC, Canada;2. Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX, United States;3. Tendyne Holdings, Roseville, MN, United States;4. Skejby University Hospital, Aarhus, Denmark;5. Beth Israel Deaconess, Boston, MA, United States;6. St Vincent''s Hospital, Sydney, Australia;7. Minneapolis Heart Institute Abbott Northwestern Hospital, Minneapolis, MN, United States;1. Divisions of Cardiology and Cardiac Imaging, St. Paul''s Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada;2. Divisions of Cardiology and Cardiac Imaging Center, Aarhus University Hospital Skejby, Aarhus, Denmark;3. Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA;4. Québec Heart and Lung Institute, Laval University, Québec, QC, Canada;1. Biomedical Engineering Program and Department of Mechanical Engineering, University of Connecticut, Storrs, CT 06269, USA;2. Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30313-2412, USA;3. Department of Mechanical Engineering, Texas Tech University, Lubbock, TX, USA |
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| Abstract: | BackgroundThe nonplanar, saddle-shaped structure of the mitral annulus has been well established through decades of anatomic and echocardiographic study. Its relevance for mitral annular assessment for transcatheter mitral valve implantation is uncertain.ObjectiveOur objectives are to define the methodology for CT-based simplified “D-shaped” mitral annular assessment for transcatheter mitral valve implantation and compare these measurements to traditional “saddle-shaped” mitral annular assessment.MethodsThe annular contour was manually segmented, and fibrous trigones were identified using electrocardiogram-gated diastolic CT data sets of 28 patients with severe functional mitral regurgitation, yielding annular perimeter, projected area, trigone-to-trigone (TT) distance, and septal-lateral distance. In contrast to the traditional saddle-shaped annulus, the D-shaped annulus was defined as being limited anteriorly by the TT distance, excluding the aortomitral continuity. Hypothetical left ventricular outflow tract (LVOT) clearance was assessed.ResultsProjected area, perimeter, and septal-lateral distance were found to be significantly smaller for the D-shaped annulus (11.2 ± 2.7 vs 13.0 ± 3.0 cm2; 124.1 ± 15.1 vs 136.0 ± 15.5 mm; and 32.1 ± 4.0 vs 40.1 ± 4.9 mm, respectively; P < .001). TT distances were identical (32.7 ± 4.1 mm). Hypothetical LVOT clearance was significantly lower for the saddle-shaped annulus than for the D-shaped annulus (10.7 ± 2.2 vs 17.5 ± 3.0 mm; P < .001).ConclusionBy truncating the anterior horn of the saddle-shaped annular contour at the TT distance, the resulting more planar and smaller D-shaped annulus projects less onto the LVOT, yielding a significantly larger hypothetical LVOT clearance than the saddle-shaped approach. CT-based mitral annular assessment may aid preprocedural sizing, ensuring appropriate patient and device selection. |
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| Keywords: | Mitral regurgitation Mitral annulus Transcatheter mitral valve implantation Transapical mitral valve replacement Computed tomography |
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