Pursuit of perfection: Three-dimensional ct angiographic 'objective quantification' of aortic valve structures for transcatheter aortic valve implantation

摘要

For patients with severe, symptomatic calcine aortic stenosis (AS) of aortic valve and a prohibitive risk of conventional surgery, a percutaneous transcatheter aortic valve replacement (TAVR) is a recommended therapeutic option. Since the introduction of TAVR in 2002, there has been increasing interest in catheter-based treatments for AS due to improved outcomes compared to medical therapy for very high risk for surgery patients. Two TAVR systems have been widely applied, namely the balloon-expandable Edwards Sapien valve (Edwards Lifesciences, Irvine, CA) and the self-expandable Core Valve system (Medtronic, Minneapolis, MN). Optimal positioning of the transcatheter aortic prosthesis is paramount to procedural success; therefore, the anatomy of the aortic valve and root has become extremely important to the "heart team." Sizing recommendations vary according to prosthesis type. The Edwards Sapien valve sizes range from 23 mm for annu-lus diameters (AD) between 18-21 mm and 26 mm for AD of 22-24 mm. The Core Valve prostheses includes a 26 mm valve for 20-23 mm AD, a 29 mm valve for 24-26 mm AD and a 31 mm valve for 26-29 mm AD.