Focus on the annuloplasty in aortic valve repair: implications from a quantitative multislice computed tomography analysis

Neumann, Niklas; Petersen, Johannes; Sinning, Christoph; Sequeira-Gross, Tatiana; Schofer, Niklas; Reichenspurner, Hermann; Girdauskas, Evaldas

doi:10.21037/qims.2020.03.16

Cited by 6 publications

(12 citation statements)

References 15 publications

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“…Our previous computed tomography (CT)‐based analyses revealed a marked diastolic annulus deformation in well‐functioning tricuspid AVs which was significantly deteriorated in AR patients 3 . Furthermore, we found a significant difference in the relation of muscular to fibrous AV annulus components between well‐functioning and regurgitant AVs 4 . Based thereon, we hypothesized that reduced diastolic AV annulus deformation is potentially induced by dysfunction of the muscular component of AV annulus (i.e., region of the right‐coronary sinus and left–right commissural area up to the left fibrous trigone), 4 which leads to continuously increased diastolic stress on the right coronary cusp.…”

Section: Introductionmentioning

confidence: 65%

A novel technique to quantify aortic valve annulus deformation: A pilot study

Holst

Petersen²,

Adam

et al. 2022

Journal of Cardiac Surgery

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Objectives We evaluated the potential of cardiac magnetic resonance (CMR)‐derived strain to assess aortic valve (AV) annulus deformation during the cardiac cycle in regurgitant and well‐functioning AVs. Methods Four patients with severe aortic regurgitation and seven healthy controls underwent CMR. Assessment of longitudinal strain was performed by hypothesizing the AV annulus would be the left ventricle in long‐axis orientation. Longitudinal strain of the segments belonging to the muscular and fibrous AV annulus was weighted and averaged to obtain regional values (RLS). Results Comparison of RLS between regurgitant and well‐functioning AVs showed a considerably different deformation of the muscular AV annulus (i.e., median RLS: 4.18 % [patients] vs. −10.41 % [controls], p = .024). The fibrous AV annulus demonstrated comparable deformational changes in both groups. Conclusion CMR‐derived strain allows for quantification of AV annulus deformation during the cardiac cycle and shows an altered RLS in the muscular AV annulus in patients with severe aortic regurgitation.

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Section: Introductionmentioning

confidence: 65%

A novel technique to quantify aortic valve annulus deformation: A pilot study

Holst

Petersen²,

Adam

et al. 2022

Journal of Cardiac Surgery

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“…A significant objective for AV surgery is the improvement of AV repair reproducibility and durability. [3][4][5] The use of a variety of AV annuloplasty techniques is undergoing a resurgence since first proposed in 1966. 9 Is there value in using CMR-based strain analysis to study bicuspid AV pathology and bicuspid AV repair?…”

Section: Discussionmentioning

confidence: 99%

“…The aortic valve (AV) annulus has become a more prominent feature for analysis as more attention is paid to percutaneous AV replacement, surgical AV repair, and homograft AV replacement. The AV annulus has been studied 1 – especially where annular contribution to aortic insufficiency is now better understood and where aortic annuloplasty accompanying AV repair is in greater use with growing evidence that it can improve AV repair durability 2–5 …”

mentioning

confidence: 99%

“…In their study, cardiovascular magnetic resonance (CMR) imaging and CMR feature‐tracking strain analysis are used to characterize aortic annular regional longitudinal strain (RLS) in humans with regurgitant AVs ( n = 4) compared to humans with normal AVs ( n = 7). Previous computed tomography (CT)‐based studies of aortic annular deformation analysis have been published 1,5 ; however, using CT‐based imaging, it is not possible to obtain feature tracking at the muscular portion of the aortic annulus. The novel modality, as reported in this study, produces increased sensitivity for the evaluation of aortic annular deformation.…”

mentioning

confidence: 99%

“…A significant objective for AV surgery is the improvement of AV repair reproducibility and durability 3–5 . The use of a variety of AV annuloplasty techniques is undergoing a resurgence since first proposed in 1966 9 .…”

mentioning

confidence: 99%

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Use of cardiac magnetic resonance imaging and cardiac magnetic resonance feature‐tracking strain analysis to characterize and differentiate aortic annular strain patterns in aortic valve regurgitation versus normal aortic valves

Hill

2022

Journal of Cardiac Surgery

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Background Understanding the aortic annulus is important for obtaining reproducible and durable aortic valve (AV) repair and allowing advances for transcatheter AV replacement treatment of aortic regurgitation (AR). Significant limitations exist when using echocardiography and computed tomography‐based imaging with feature tracking at the aortic annulus. Aims Cardiac magnetic resonance is used to obtain regional longitudinal strain and can be modified to obtain circumferential annular strain at the fibrous and muscular portions of the AV annulus. Materials and Methods Holst et al. use a novel method to characterize and prove that adverse annular deformation occurs at the muscular portion of the AV annulus in patients with AR. In their study, cardiovascular magnetic resonance (CMR) imaging and CMR feature‐tracking strain analysis are used to characterize aortic annular regional longitudinal strain (RLS) in humans. Results The authors convincing show that the direction of muscular annular deformation in patients with AR is opposite to the direction of muscular annular deformation in patients with normal Avs, (median RLS: 4.18% in patients with severe AR vs. −10.41% in well‐functioning AVs, p = .024; at RLS muscular annulus). Discussion and Conclusion The direction of muscular annular deformation in patients with AR is opposite to the direction of muscular annular deformation in patients with normal AVs. This information will have impactful physiological relevance for surgical and percutaneous treatment of aortic valve pathology.

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Aortic regurgitation: A multimodality approach

Siani

Perone²,

Costantini

et al. 2022

J of Clinical Ultrasound

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Aortic regurgitation (AR) is a common valvular pathology. Multimodality noninvasive cardiovascular imaging is routinely used to assess the mechanism of AR, degree, and its hemodynamic impact on the cardiovascular system. Collecting this information is crucial in establishing the prognosis and in guiding patient management and follow‐up. While echocardiography remains the primary test to assess AR, a comprehensive assessment of this valvulopathy can be obtained by combining the information from different techniques. This state‐of‐the‐art review is intended to provide an update ed overview of the applications, strengths, and limits of transthoracic echocardiography, cardiac magnetic resonance, and cardiac computed tomography in patients with AR.

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Focus on the annuloplasty in aortic valve repair: implications from a quantitative multislice computed tomography analysis

Cited by 6 publications

References 15 publications

A novel technique to quantify aortic valve annulus deformation: A pilot study

A novel technique to quantify aortic valve annulus deformation: A pilot study

Use of cardiac magnetic resonance imaging and cardiac magnetic resonance feature‐tracking strain analysis to characterize and differentiate aortic annular strain patterns in aortic valve regurgitation versus normal aortic valves

Aortic regurgitation: A multimodality approach

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