Computed tomography guided sizing for transcatheter pulmonary valve replacement
Objective: To evaluate the predictive value of Computed Tomography Angiography (CTA) measurements of the RVOT for transcatheter valve sizing. Background: Transcatheter pulmonary valve replacement (TPVR) provides an alternative to surgery in patients with right ventricular outflow tract (RVOT) dysfun...
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2020-08-01
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Series: | International Journal of Cardiology: Heart & Vasculature |
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doaj-fd21a99c7b8d472a84a8fd4dd75e0b922020-11-25T03:12:03ZengElsevierInternational Journal of Cardiology: Heart & Vasculature2352-90672020-08-0129100523Computed tomography guided sizing for transcatheter pulmonary valve replacementLara Curran0Harsh Agrawal1Kimberly Kallianos2Ahmed Kheiwa3Shezhang Lin4Karen Ordovas5Vaikom S Mahadevan6Department of Cardiology, University of California, San Francisco, United StatesDepartment of Cardiology, University of California, San Francisco, United StatesDepartment of Radiology and Biomedical Imaging, University of California, San Francisco, United StatesLoma Linda University International Heart Institute, United StatesDepartment of Radiology and Biomedical Imaging, University of California, San Francisco, United StatesDepartment of Radiology and Biomedical Imaging, University of California, San Francisco, United StatesDepartment of Cardiology, University of California, San Francisco, United States; Corresponding author at: Division of Cardiology, University of California, 505 Parnassus Avenue, San Francisco, CA 94143, United States.Objective: To evaluate the predictive value of Computed Tomography Angiography (CTA) measurements of the RVOT for transcatheter valve sizing. Background: Transcatheter pulmonary valve replacement (TPVR) provides an alternative to surgery in patients with right ventricular outflow tract (RVOT) dysfunction. We studied 18 patients who underwent catheterization for potential TPVR to determine whether CT imaging can be used to accurately predict implant size. Methods: Cases were grouped by RVOT characteristics: native or transannular patch (n = 8), conduit (n = 5) or bioprosthetic valve (n = 5). TPVR was undertaken in 14/18 cases, after balloon-sizing was used to confirm suitability and select implant size. Retrospective CT measurements of the RVOT (circumference-derived (Dcirc) and area-derived (Darea) diameters) were obtained at the level of the annulus, bioprosthesis or conduit. Using manufacturer sizing guidance, a valve size was generated and a predicted valve category assigned: (1) <18 mm, (2) 18–20 mm, (3) 22–23 mm, (4) 26–29 mm and (5) >29 mm. Predicted and implanted valves were compared for inter-rater agreement using Cohen’s kappa coefficient. Results: The median age of patients was 37 years old (IQR: 30–49); 55% were male. Diagnoses included: Tetralogy of Fallot (12/18), d-Transposition repair (3/18), congenital pulmonary stenosis (2/18) and carcinoid heart disease (1/18). Measurements of Darea (κ = 0.697, p < 0.01) and Dcirc (κ = 0.540, p < 0.01) were good predictors of implanted valve size. When patients with RVOT conduits were excluded, the predictive accuracy improved for Darea (κ = 0.882, p < 0.01) and Dcirc (κ = 0.882, p < 0.01). Conclusions: CT measurement of the RVOT, using Darea or Dcirc, can predict prosthetic valve sizing in TPVR. These measurements are less predictive in patients with conduits, compared to those with a native RVOT or pulmonic bioprosthesis. Condensed abstract: We studied 18 patients who underwent catheterization for TPVR to determine whether CT imaging could be used to accurately predict implant size. Retrospective RVOT measurements were used to generate a predicted valve size, which was compared with implanted valve size for inter-rater agreement. Measurements of Darea (κ = 0.697, p < 0.01) and Dcirc (κ = 0.540, p < 0.01) were good predictors of implanted valve size. When cases with RVOT conduits were excluded, the predictive accuracy improved for Darea (κ = 0.882, p < 0.01) and Dcirc (κ = 0.882, p < 0.01). CT measurement of the RVOT can accurately predict prosthetic valve sizing in TPVR. These measurements are less predictive in patients with conduits.http://www.sciencedirect.com/science/article/pii/S2352906719302982 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Lara Curran Harsh Agrawal Kimberly Kallianos Ahmed Kheiwa Shezhang Lin Karen Ordovas Vaikom S Mahadevan |
spellingShingle |
Lara Curran Harsh Agrawal Kimberly Kallianos Ahmed Kheiwa Shezhang Lin Karen Ordovas Vaikom S Mahadevan Computed tomography guided sizing for transcatheter pulmonary valve replacement International Journal of Cardiology: Heart & Vasculature |
author_facet |
Lara Curran Harsh Agrawal Kimberly Kallianos Ahmed Kheiwa Shezhang Lin Karen Ordovas Vaikom S Mahadevan |
author_sort |
Lara Curran |
title |
Computed tomography guided sizing for transcatheter pulmonary valve replacement |
title_short |
Computed tomography guided sizing for transcatheter pulmonary valve replacement |
title_full |
Computed tomography guided sizing for transcatheter pulmonary valve replacement |
title_fullStr |
Computed tomography guided sizing for transcatheter pulmonary valve replacement |
title_full_unstemmed |
Computed tomography guided sizing for transcatheter pulmonary valve replacement |
title_sort |
computed tomography guided sizing for transcatheter pulmonary valve replacement |
publisher |
Elsevier |
series |
International Journal of Cardiology: Heart & Vasculature |
issn |
2352-9067 |
publishDate |
2020-08-01 |
description |
Objective: To evaluate the predictive value of Computed Tomography Angiography (CTA) measurements of the RVOT for transcatheter valve sizing. Background: Transcatheter pulmonary valve replacement (TPVR) provides an alternative to surgery in patients with right ventricular outflow tract (RVOT) dysfunction. We studied 18 patients who underwent catheterization for potential TPVR to determine whether CT imaging can be used to accurately predict implant size. Methods: Cases were grouped by RVOT characteristics: native or transannular patch (n = 8), conduit (n = 5) or bioprosthetic valve (n = 5). TPVR was undertaken in 14/18 cases, after balloon-sizing was used to confirm suitability and select implant size. Retrospective CT measurements of the RVOT (circumference-derived (Dcirc) and area-derived (Darea) diameters) were obtained at the level of the annulus, bioprosthesis or conduit. Using manufacturer sizing guidance, a valve size was generated and a predicted valve category assigned: (1) <18 mm, (2) 18–20 mm, (3) 22–23 mm, (4) 26–29 mm and (5) >29 mm. Predicted and implanted valves were compared for inter-rater agreement using Cohen’s kappa coefficient. Results: The median age of patients was 37 years old (IQR: 30–49); 55% were male. Diagnoses included: Tetralogy of Fallot (12/18), d-Transposition repair (3/18), congenital pulmonary stenosis (2/18) and carcinoid heart disease (1/18). Measurements of Darea (κ = 0.697, p < 0.01) and Dcirc (κ = 0.540, p < 0.01) were good predictors of implanted valve size. When patients with RVOT conduits were excluded, the predictive accuracy improved for Darea (κ = 0.882, p < 0.01) and Dcirc (κ = 0.882, p < 0.01). Conclusions: CT measurement of the RVOT, using Darea or Dcirc, can predict prosthetic valve sizing in TPVR. These measurements are less predictive in patients with conduits, compared to those with a native RVOT or pulmonic bioprosthesis. Condensed abstract: We studied 18 patients who underwent catheterization for TPVR to determine whether CT imaging could be used to accurately predict implant size. Retrospective RVOT measurements were used to generate a predicted valve size, which was compared with implanted valve size for inter-rater agreement. Measurements of Darea (κ = 0.697, p < 0.01) and Dcirc (κ = 0.540, p < 0.01) were good predictors of implanted valve size. When cases with RVOT conduits were excluded, the predictive accuracy improved for Darea (κ = 0.882, p < 0.01) and Dcirc (κ = 0.882, p < 0.01). CT measurement of the RVOT can accurately predict prosthetic valve sizing in TPVR. These measurements are less predictive in patients with conduits. |
url |
http://www.sciencedirect.com/science/article/pii/S2352906719302982 |
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