Feasibility of cardiovascular magnetic resonance to assess the orifice area of aortic bioprostheses

Item Type:	Article
Title:	Feasibility of cardiovascular magnetic resonance to assess the orifice area of aortic bioprostheses
Creators Name:	von Knobelsdorff-Brenkenhoff, F. and Rudolph, A. and Wassmuth, R. and Bohl, S. and Buschmann, E.E. and Abdel-Aty, H. and Dietz, R. and Schulz-Menger, J.
Abstract:	BACKGROUND: Prosthetic orifice area, usually calculated by transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE), provides important information regarding the hemodynamic performance of aortic bioprostheses. However, both TTE and TEE have limitations; therefore accurate and reproducible determination of the orifice area often remains a challenge. The present study aimed to investigate the feasibility of cardiovascular magnetic resonance (CMR) to assess the orifice areas of aortic bioprostheses. METHODS AND RESULTS: CMR planimetry of the orifice area was performed in 65 patients (43/22 stented/stentless prostheses; mean time since implantation, 3.1+/-2.8 years; mean orifice area [TTE], 1.70+/-0.43 cm(2); 62 normally functioning prostheses, 2 severe stenoses, and 1 severe regurgitation) in an imaging plane perpendicular to the transprosthetic flow using steady-state free-precession cine imaging under breath-hold conditions on a 1.5-T MR system. CMR results were compared with TTE (continuity equation, n=65) and TEE (planimetry, n=31). CMR planimetry was readily feasible in 80.0%; feasible with limitation in 15.4% because of stent, flow, and sternal wire artifacts; and impossible in 4.6% because of flow artifacts. Correlations of the orifice areas by CMR with TTE (r=0.82) and CMR with TEE (r=0.92) were significant. The average difference between the methods was -0.02+/-0.24 cm(2) (TTE) and 0.05+/-0.15 cm(2) (TEE). Agreement was present for stented and stentless devices and independent of orifice size. Intraobserver and interobserver variabilities of CMR planimetry were 6.7+/-5.4% and 11.5+/-7.8%. CONCLUSIONS: The assessment of aortic bioprostheses with normal orifice areas by CMR is technically feasible and provides orifice areas with a close correlation to echocardiography and low observer dependency.
Keywords:	Imaging, MRI, Echocardiography, Valves, Surgery
Source:	Circulation Cardiovascular Imaging
ISSN:	1941-9651
Publisher:	American Heart Association
Volume:	2
Number:	5
Page Range:	397-404
Date:	September 2009
Official Publication:	https://doi.org/10.1161/CIRCIMAGING.108.840967
PubMed:	View item in PubMed

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