Deformation of Surgically Implanted Aortic Valves: CT Findings Prior to Valve-in-Valve Implantation and Association With Mechanism of Failure

Figures

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  Central Illustration. Deformation of surgically implanted aortic valves and potential association with valve degeneration and failure. BPV, bioprosthetic valve; CT, cardiac computed tomography; Echo, echocardiography; EI, eccentricity index; ViV, valve-in-valve.

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  Figure 1. CT scan measurements of a normally looking stented bioprosthetic valve. (A) Appearance of a stented bioprosthetic valve on CT scan. The struts of the stent and the valve ring are highlighted. (B) PGOA and strut-to-strut distance measurements: normally looking struts with similar strut-to-strut distances (1, 2, 3) (∼19 mm). PGOA (blue circle) = 377 mm2 (diameter: 21.9 mm). (C) Example of strut angle measurement. 1: Anteromedial angle = 91°. (D) Measurements of a normally looking ring. Inner min and max diameters: 20.7 × 20 mm, inner ring area: 325 mm2, inner ring perimeter: 64 mm. CT, cardiac computed tomography; PGOA, projected geometric orifice area.

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  Figure 2. Severely distorted strut. (A) Markedly distorted strut with reduced anteromedial angle (66°). (B) Same valve (Perimount 21 mm implanted in a small aortic annulus [20.7 × 23.3 mm]) with 3D appearance on CT scan. (C) Slightly deformed ring of the same valve. (D) Strut-to-strut distance is the smallest between the anteromedial (AM) and the anterolateral (AL) struts (distance 3 = 12 mm) due to strut distortion/angulation. Blue circle represents projected geometric orifice area of the stent; small green circle: AM aspect; small red circle: AL aspect; small yellow circle: posterior aspect. Images are representative of the same valve (same patient, same CT scan). CT, cardiac computed tomography.

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  Figure 3. Severely deformed ring. (A, B) Severely deformed ring with maximum diameter =19 mm and minimum diameter = 10 mm (ratio = 1.9 and eccentricity index >10%) in a Trifecta 19 mm valve. (C) Distorted struts resulting in significantly shorter strut-to-strut distance 2 (11.8 mm) as compared with distance 1 (13.6 mm) and distance 3 (15.4 mm). Projected geometric orifice area of the stent (blue circle): 200 mm2. Images are representative of the same valve (same patient, same cardiac computed tomography scan).

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  Figure 4. Correlation between the changes in strut angles and the changes in PGOA. (A-C) Correlation between the changes in PS (A), AL (B), and AM (C) angles and the changes in PGOA. AL, anterolateral; AM, anteromedial; PGOA, projected geometric orifice area of the stent; PS, posteroseptal.