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Vol. 67. Issue 6.
Pages 500-501 (June 2014)
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Vol. 67. Issue 6.
Pages 500-501 (June 2014)
Letter to the Editor
DOI: 10.1016/j.rec.2014.02.004
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Specific Modeling and Quantification of the Aortic Valve
Modelo de cuantificación específico de la válvula aórtica
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Gonenc Kocabay
Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
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To the Editor,

I read with great interest the article “New Quantitative Model of Aortic Valve in PreTAVI Patients.”1 The authors implemented a new, specialized software (Auto Valve Analysis, Siemens; California, United Stated) to evaluate transcatheter aortic valve implantation. Although the authors focused only on aortic annulus, this novel software can provide more accurate and additional information to the interventional cardiologist.

For patients presenting with severe aortic stenosis and at high risk for surgery transcatheter aortic valve implantation, this is an alternative therapy.2,3 Coronary obstruction due to the displacement of the calcified native valve leaflets over the coronary ostia, especially in the setting of lower-lying coronary ostium and shallow sinus of Valsalva, is a life-threatening complication of transcatheter aortic valve implantation. The combination of a relatively low-lying coronary artery ostium and a large native aortic valvar leaflet can obstruct the flow. Therefore, it is essential to assess the relation between ostia and leaflet position before the procedure. Additionally, the width of the sinus of Valsalva should be assessed. Aortography, computed tomography, and transesophageal echocardiography are used to evaluate the annulo-ostial distance and width of sinus of Valsalva. With the advent of the automated quantitative modeling of the aortic root from 3D-transesophageal echocardiography (Auto Valve Analysis, Siemens), leaflet anatomy (leaflet length and height), annulus to coronary ostia distance, and height and width of sinus of Valsalva can be measured. Besides the assessment of aortic annulus to determine the ideal implant valve size, the position of the coronary arteries relative to the aortic leaflets (annulus-leaflet-ostia relationship) can be assessed by this novel software.4,5

The aortic annulus is formed by joining the basal attachment points of the leaflets within the left ventricle.6 The shape of the annulus is noncircular, may be oval or elliptical shape, and with calcification becomes nonhomogenous. The noncircularity of the aortic annulus and the presence of dense calcium limit the applicability of two-dimensional imaging in estimating the annulus diameter for valve sizing. This has led to a great debate over the choice for measuring optimal diameter. However, this novel software determines the dimensions of the aortic annulus, including maximum and minimum diameter, perimeter, and cross-sectional area.

Prospective studies are necessary to show the feasibility and the impact on transcatheter aortic valve implantation procedures.

Funding

Gonenc Kocabay is the recipient of a research grant funded by the European Association of Cardiovascular Imaging.

References
[1]
A. García-Martín, C. Fernández-Golfín, J.L. Zamorano-Gómez.
Nuevo modelo de cuantificación aórtica en pacientes pre-TAVI.
Rev Esp Cardiol, 67 (2014), pp. 488
[2]
H.B. Ribeiro, J.G. Webb, R.R. Makkar, M.G. Cohen, S.R. Kapadia, S. Kodali, et al.
Predictive factors, management, and clinical outcomes of coronary obstruction following transcatheter aortic valve implantation: insights from a large multicenter registry.
J Am Coll Cardiol, 62 (2013), pp. 1552-1562
[3]
H.B. Ribeiro, L. Nombela-Franco, M. Urena, M. Mok, S. Pasian, D. Doyle, et al.
Coronary obstruction following transcatheter aortic valve implantation: a systematic review.
JACC Cardiovasc Interv, 6 (2013), pp. 452-461
[4]
R.I. Ionasec, I. Voigt, B. Georgescu, Y. Wang, H. Houle, F. Vega-Higuera, et al.
Patient-specific modeling and quantification of the aortic and mitral valves from 4-D cardiac CT and TEE.
IEEE Trans Med Imaging, 29 (2010), pp. 1636-1651
[5]
A. Calleja, P. Thavendiranathan, R.I. Ionasec, H. Houle, S. Liu, I. Voigt, et al.
Automated quantitative 3-dimensional modeling of the aortic valve and root by 3-dimensional transesophageal echocardiography in normals, aortic regurgitation, and aortic stenosis: comparison to computed tomography in normals and clinical implications.
Circ Cardiovasc Imaging, 6 (2013), pp. 99-108
[6]
N. Piazza, P. De Jaegere, C. Schultz, A.E. Becker, P.W. Serruys, R.H. Anderson.
Anatomy of the aortic valvar complex and its implications for transcatheter implantation of the aortic valve.
Circ Cardiovasc Interv, 1 (2008), pp. 74-81
Copyright © 2014. Sociedad Española de Cardiología
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