Abstract
BackgroundTranscatheter aortic valve implantation involves percutaneously implanting a biomechanical aortic valve to treat severe aortic stenosis. In order to select a proper device, precise sizing of the aortic valve annulus must be completed.MethodsIn this paper, we describe a fully automatic segmentation method to measure the aortic annulus diameter in patients with aortic calcification, operating on 3-dimensional transesophageal echocardiographic images. The method is based on state estimation of a subdivision surface representation of the left ventricular outflow tract and aortic root. The state estimation is solved by an extended Kalman filter driven by edge detections normal to the subdivision surface.ResultsThe method was validated on echocardiographic recordings of 16 patients. Comparison against two manual measurements showed agreements (mean ±SD) of -0.3±1.6 and -0.2±2.3 mm for perimeter-derived diameters, compared to an interobserver agreement of -0.1±2.1 mm.ConclusionsWith this study, we demonstrated the feasibility of an efficient and fully automatic measurement of the aortic annulus in patients with aortic disease. The algorithm robustly measured the aortic annulus diameter, providing measurements indistinguishable from those done by cardiologists.
Highlights
Transcatheter aortic valve implantation involves percutaneously implanting a biomechanical aortic valve to treat severe aortic stenosis
Because of its minimally invasive nature, Transcatheter Aortic Valve Implantation (TAVI) is a viable alternative for patients who are at too high risk to undergo conventional surgical aortic valve replacement
Measurement of the annulus diameter before TAVI is typically done by 2D transthoracic echocardiography, 2D Transoesophageal Echocardiography (TEE) or Multi-Slice Computed Tomography (MSCT)
Summary
Transcatheter aortic valve implantation involves percutaneously implanting a biomechanical aortic valve to treat severe aortic stenosis. In order to select a proper device, precise sizing of the aortic valve annulus must be completed. Transcatheter Aortic Valve Implantation (TAVI) involves percutaneously implanting a biomechanical aortic valve to treat severe aortic stenosis. Precise sizing of the aortic annulus prior to TAVI is required for determining procedure eligibility and for selecting the correct implant size and type. It has been shown that sizing based on MSCT, as opposed to 2D TEE, results in fewer instances of post operational PAR [2], as 2D modalities can fail to accurately describe the 3D structure of the aortic valve [3,4,5]. Strong correlations between 3D TEE and MSCT measurements of the annulus diameter [4] indicate feasibility of similar results for a method based on 3D TEE
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