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Archives of cardiovascular diseases
Volume 106, n° 4
page 261 (avril 2013)
Doi : 10.1016/j.acvd.2013.03.044

Location and thickness of annulus calcification predicts paravalvular aortic regurgitation after TAVI. Standardized segmentation of aortic annulus through multimodality imaging techniques

V. Ciobotaru, E. Maupas, N. Durrleman
 Clinique les Franciscaines, Nîmes, France 

Since TAVI involves multimodality imaging to screen patients it is highly important to standardize the report and the analysis process of the AO valve.

Our aim .– To explore whether the precise location of the annulus calcifications could predict periprosthetical aortic regurgitation (PAR) after TAVI.

Method .– We propose a standardized aortic annulus description based on a “clock” segmentation. Cardiac CT was performed in 49 patients before and after TAVI and compared to the echo after TAVI. Aortic Annulus was divided into 12 quadrants. Six o’clock was defined as the insertion of interatrial septum on the aortic annulus. The calcic protrusion was assessed as the thickness of calcic annular apposition.

Results .– Number of patients with PAR2: 18/49 (36%) of which patients with two or more PAR (non-adjacent): 50% (9/18).

Correlation between annulus calcium location and PAR: P coef correlation 0.93.

The annulus calcic protrusion was more predictive of PAR (AUC 0.9) than the aortic calcic score (AUC 0.6).

The thickness of the protrusive calcic annular apposition correlates with the grade of the AO regurgitation.

Conclusion .– We propose a standardized aortic annulus clockwise segmentation to describe aortic annular calcifications and periprosthetical regurgitations, to improve inter-modality imaging analysis.

We found:

– a very strong correlation between the annulus calcification location, the sites and number of periprosthetical regurgitations;

– that the thickness of the annulus calcic protrusion predicts the degree of the PAR more accurately than valvular global calcium quantification.

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© 2013  Published by Elsevier Masson SAS.
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