Computed tomography for planning and postoperative imaging of transvenous mitral annuloplasty: first experience in an animal model

Abstract

To investigate the use of computed tomography (CT) to measure the mitral valve annulus size before implantation of a percutaneous mitral valve annuloplasty device in an animal trial. Seven domestic pigs underwent CT before and after implantation of a Cardioband™ (a percutaneously implantable mitral valve annuloplasty device) with a second-generation 128-section dual-source CT machine. Implantation of the Cardioband™ was performed in a standard fashion according to a protocol. Animals were sacrificed afterwards and the hearts explanted. The Cardioband™ was found to be adequately implanted in all animals, with no anchor dehiscence and no damage of the circumflex artery (CX) or the coronary sinus (CS). The correct length of the band as chosen according to the length of the posterior mitral annulus measured in CT before implantation was confirmed in gross examination in all animals. The device did not result in a metal artifact-related degradation of image quality. The closest distance from the closest anchor to the CX was 2.1 ± 0.7 mm in diastole and 1.6 ± 0.5 mm systole. Mitral annulus distance to the CS was 6.4 ± 1.3 mm in diastole and 7.7 ± 1.1 mm in systole. CT visualization and measurement of the mitral valve annulus dimensions is feasible and can become the imaging method of choice for procedure planning of Cardioband™ implantations or other transcatheter mitral annuloplasty devices.

Cardiovascular imaging 2014 in the International Journal of Cardiovascular Imaging

“…One study investigated the use of computed tomography (CT) to measure mitral valve annulus size before implantation of a percutaneous mitral valve annuloplasty device in an animal trial. [80] Seven domestic pigs underwent CT before and after implantation of a Cardioband TM with a second-generation 128-section dualsource CT scanner. Implantation of the Cardioband TM was performed in a standard fashion.…”

Computed Tomography-based evaluation of porcine cardiac dimensions to assist in pre-study planning and optimized model selection for pre-clinical research

“…As both scenarios have a negative impact on the informative value of the preclinical study results, appropriate annular measurements and prosthesis sizing are considered critical. A better understanding of cardiac morphometries, including the inter-species differences and intra-species anatomical variabilities, is thereby essential to improve safety and efficacy in non-clinical device evaluation [14][15][16] and to concurrently reduce the possibility of misleading and meaningless study results lacking transferability 35 .…”

“…High profile valves may also cause obstruction of the left ventricular outflow tract due to the geometric relationship between the aortic and the mitral valve 13 . Pre-procedural planning with modern imaging modalities such as trans-esophageal echocardiography and three-dimensional computed tomography (CT) have shown to lead to a better understanding of annular sizing and geometry and a reduction of these complications and have therefore become an integral part in the clinical assessment of patients 10,[14][15][16] .…”

Association of transcatheter direct mitral annuloplasty with acute anatomic, haemodynamic, and clinical outcomes in severe mitral valve regurgitation

“…Individual decision for interventional direct annuloplasty as choice for TMVR was taken at the team's discretion respecting pathomechanism of MR and assessment of anatomical suitability for direct annuloplasty as well as other available forms of TMVR and approved by specialists of the manufacturing company. Anatomical feasibility was evaluated (and confirmed by experts of the manufacturing company) by a protocol of transesophageal echocardiography (TEE) and computed tomography (CT, for specifications of CT protocol in detail, see reference 12 ), which were also used for planning the procedure (e.g. planning fluoroscopic angulations, optimal height of trans-septal puncture and anchor implantation zones, and selection of the size of the device).…”