P002. 4D CT Analysis of the Bicuspid Aortic Valve
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
Limoges
France - Contact Me
I trained in cardiac surgery at Hotel-Dieu de France (Lebanon) and at Hospice Civil de Lyon and Limoges University Hospital (France). I am a member of the french society of cardiothoracic surgery. I recently obtained a masters of science for my work on the aortic valve.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objectives: To evaluate the role of 4D analysis using multiphase computed tomography (MCCT) in the description of the aortic annulus (AA) of the bicuspid aortic valves (BAV) with regards to the latest expert consensus classification and to describe the morphometrics of the different types of BAV.
Methods: 15 ECG-gated MCCT of patients with normal BAV were analyzed using an in-house software. The AA border was pinpointed on 9 reconstructed planes and the 3D coordinates of the 18 consecutive points were interpolated into a 3D curve using a cubic spline to calculate 3D areas, perimeters, all diameters, eccentricity indexes and global height. Three additional planes were generated at the level of the left ventricular outflow tract (LVOT), the level of the Valsalva sinuses and the level of the sinotubular junction (STJ). This procedure was repeated for all the 10 temporal phases of the RR interval. 15 additional ECG-gated MCCT of patients with normal tricuspid aortic valve (TAV) were analyzed for comparison.
Results: The annulus was significantly larger in BAV than in TAV in terms of area, perimeter, diameters, and height. The Valsalva sinuses and the STJ were also significantly larger in BAV compared to TAV (mean area in end-diastole of 6.06±1 cm² vs 4.69±1 cm², p<0.001 and 5.13±1.62 cm² vs 3.62+/ 0.99 cm², p= 0.001 respectively). In BAV, 3D AA shape analysis helps to distinguish the 3 types of BAV: the 2-sinus type (symmetrical), the fused type, and the partial-fusion type or form fruste (both asymmetrical). It also allows to determine the position and the height of the nonfunctional commissure. In symmetrical BAV, the non-functional commissure was significantly lower than the other commissures (6.01±4.27 mm vs 18.24±3.2 mm vs 17.15±3.6 mm, p <0.001) whereas in asymmetrical BAV, the 3 commissures had comparable heights (16.38±0.86 mm vs 15.88±1.69 mm vs 15.37±0.88 mm, p=0.316). There was no difference in the AA eccentricity indexes between TAV and BAV at all phases of the cardiac cycle. However, there was a spectrum of ellipticity of the other components of the aortic root between the different types of valves: at end-diastole, going from TAV to asymmetrical BAV to symmetrical BAV, the LVOT became more circular, and the Valsalva sinuses became more elliptical (Figure).
Conclusion: 3D morphometric analysis of the BAV using MCCT allows to identify the type of BAV, and to describe the position and height of the nonfunctional commissure. There are significan
Authors
amine fikani (1), Damian Craiem (2), cyrille boulogne (3), Gilles Soulat (4), Elie Mousseaux (4), Jerome Jouan (1)
Institutions
(1) Limoges University Hospital, France, (2) Favaloro University, Instituto de Medicina Traslacional, Trasplante y Bioingeniería, CONICET, Buenos Aires, NA, (3) Limoges University Hospital, Limoges, Haute Vienne, (4) Department of Radiology, Georges Pompidou European Hospital, Paris, NA
Methods: 15 ECG-gated MCCT of patients with normal BAV were analyzed using an in-house software. The AA border was pinpointed on 9 reconstructed planes and the 3D coordinates of the 18 consecutive points were interpolated into a 3D curve using a cubic spline to calculate 3D areas, perimeters, all diameters, eccentricity indexes and global height. Three additional planes were generated at the level of the left ventricular outflow tract (LVOT), the level of the Valsalva sinuses and the level of the sinotubular junction (STJ). This procedure was repeated for all the 10 temporal phases of the RR interval. 15 additional ECG-gated MCCT of patients with normal tricuspid aortic valve (TAV) were analyzed for comparison.
Results: The annulus was significantly larger in BAV than in TAV in terms of area, perimeter, diameters, and height. The Valsalva sinuses and the STJ were also significantly larger in BAV compared to TAV (mean area in end-diastole of 6.06±1 cm² vs 4.69±1 cm², p<0.001 and 5.13±1.62 cm² vs 3.62+/ 0.99 cm², p= 0.001 respectively). In BAV, 3D AA shape analysis helps to distinguish the 3 types of BAV: the 2-sinus type (symmetrical), the fused type, and the partial-fusion type or form fruste (both asymmetrical). It also allows to determine the position and the height of the nonfunctional commissure. In symmetrical BAV, the non-functional commissure was significantly lower than the other commissures (6.01±4.27 mm vs 18.24±3.2 mm vs 17.15±3.6 mm, p <0.001) whereas in asymmetrical BAV, the 3 commissures had comparable heights (16.38±0.86 mm vs 15.88±1.69 mm vs 15.37±0.88 mm, p=0.316). There was no difference in the AA eccentricity indexes between TAV and BAV at all phases of the cardiac cycle. However, there was a spectrum of ellipticity of the other components of the aortic root between the different types of valves: at end-diastole, going from TAV to asymmetrical BAV to symmetrical BAV, the LVOT became more circular, and the Valsalva sinuses became more elliptical (Figure).
Conclusion: 3D morphometric analysis of the BAV using MCCT allows to identify the type of BAV, and to describe the position and height of the nonfunctional commissure. There are significan
Authors
amine fikani (1), Damian Craiem (2), cyrille boulogne (3), Gilles Soulat (4), Elie Mousseaux (4), Jerome Jouan (1)
Institutions
(1) Limoges University Hospital, France, (2) Favaloro University, Instituto de Medicina Traslacional, Trasplante y Bioingeniería, CONICET, Buenos Aires, NA, (3) Limoges University Hospital, Limoges, Haute Vienne, (4) Department of Radiology, Georges Pompidou European Hospital, Paris, NA
Presentation Duration
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