Abstract 20012: Measuring the Sinuses of Valsalva and Left Ventricular Outflow Tract by Cardiac Computed Tomographic Angiography: Incremental Value for Sizing the Valve for Transcatheter Aortic Valve Replacement?

Abstract

Background: Accurate assessment of aortic annulus size (AoA) is critical for insuring successful transcatheter aortic valve replacement (TAVR) as well as to minimize para-valvular regurgitation. However, the AoA is occasionally difficult to assess due to challenges caused by annular calcification, motion artifact and improper CT gating. Proper TAVR valve size and sealing is dependent more than just AoA, but rather multiple other measurements including the left ventricular outflow tract (LVOT) diameters and sinuses of Valsalva. We hypothesized that the measurement of sinuses of Valsalva and LVOT by cardiac computed tomographic angiography (CCTA) imaging are important adjunctive measurements in determining the ideal valve size for TAVR. Methods: Consecutive patients evaluated for TAVR underwent single phase, prospective ECG gated CCTA with contrast to evaluate the aortic valve anatomy. Measurements of annular, coronary height, left ventricular outflow tract diameters and areas were performed. Findings were analyzed using ANOVA and regression models. Results: CCTA was performed on 87 patients being evaluated for TAVR. Increasing body surface area (BSA) is weakly associated with AoA and somewhat correlated with sinotubular junction measurements. Sinuses of Valsalva and LVOT are strongly predictive of AoA and the ideal valve size (r 2 =0.66, r 2 =0.86, respectively). Sinuses of Valsalva and LVOT are helpful predictive adjuncts along with AoA in determining the ideal valve size for TAVR, specifically in those with the smallest and largest annular areas (figure 1). Coronary heights were not associated with AoA or BSA. Conclusion: There is a strong association between the annulus size and sinuses of Valsalva diameter and LVOT measured by CCTA. This finding is particularly useful in determining the appropriate valve size in those borderline cases or when accurate aortic annulus dimensions are difficult to obtain.