Rotational angiography for preinterventional imaging in transcatheter aortic valve implantation.

OBJECTIVE: To evaluate the clinical value of 3D rotational angiography, as a tool for imaging and measuring 3D anatomy, coupled with transesophageal echocardiogram (TEE) as preinterventional imaging for transcatheter aortic valve implantation (TAVI) procedures.

BACKGROUND: TAVI is a growing field in cardiology. An understanding of the 3D anatomy of the aortic root is crucial for patient selection and for the optimal planning and guidance of such procedures. Current techniques include 3D imaging (with MSCT MRI and 3D TEE) combined with multiplane TEE. Nevertheless, a gold standard of 3D imaging is yet not defined. 3D rotational angiography provides 3D anatomy information in the cathlab. Initially designed for nonmoving anatomical structures, one can adapt the protocol to temporarily minimize the heart anatomy motion during rotational angiography.

METHODS: Ninety-nine consecutive patients (61 females, 38 males, age 80.9 ± 5.2 years) with symptomatic aortic stenosis underwent 3D rotational angiography to assess the anatomical suitability of potential TAVI candidates. 3D rotational angiography with a C-Arm (Innova 3100(IQ) , GE Healthcare, Chalfont St Giles, UK) was performed to create the 3D anatomy of the aortic root. Coronary angiography and pelvic vessel angiography were performed during the same examination. Measurements of the aortic annulus and the sinotubular junction were made on the 3D cross-sections and were compared to TEE. Radiation dose to the patient was also monitored.

RESULTS: In all 99 patients, 3D rotational angiography was performed successfully with good imaging of the aortic root and measurements of the aortic annulus. In patients scheduled for SAPIEN valve implantation, the distances from the annulus to the coronary ostia were also measured. Of 99 patients, 80 subsequently underwent successful implantation. There is a good correlation to the TEE in the measured aortic annulus (22.13 ± 2.09 mm in rotational angio, 21.58 ± 2.09 mm TEE, Spearman r = 0.88, 95% IC [0.83;0.92], P < 0.0001) and sinotubular junction (26.19 ± 2.71 mm in rotational angio, 26.22 ± 2.73 mm TEE, Spearman r = 0.83, 95% IC [0.75;0.88], P < 0.0001). The effective dose is a fraction of the X-ray dose required for multi-slice computed tomography.

CONCLUSION: Given that this technology is available in the cathlab at reasonable dose levels, 3D rotational angiography has proven to be a suitable preinterventional 3D imaging modality for TAVI procedures. Together, the raw angiographic data and the reconstructed 3D volume provide all the necessary anatomical information necessary for this procedure, including the measurements.