The Role of Quantitative Aortographic Assessment of Aortic Regurgitation by Videodensitometry in the Guidance of Transcatheter Aortic Valve Implantation

Figure 1. Flowchart of this study. TAVI: transcatheter aortic valve implantation; VD-RA: Videodensitometric of aortic regurgitation; TEE: transesophageal echocardiography.

Figure 2. Videodensitometric assessment of aortic regurgitation. A) Delineation of the aortic root (reference region: red area in the aortography) and the subaortic one third of LV (ROI: yellow area in the aortography) are shown by the analyser. The time-density curves are provided for both ROI (yellow) and reference (red) regions, and the AUC is automatically computed by the software time-density integrals. VD-AR corresponds to the relative AUC, which is automatically calculated as the ratio of the relative AUC in the ROI (yellow) to that in the reference area (red). Theoretically, the value of VD-AR ranges from 0 to 1. B) An example of VD-AR measurement before BPD. C) An example of VD-AR measurement after BPD. Reproduce and adopted from Tateishi et al. EuroIntervention 201614

Figure 3. Serial changes of the Videodensitometric-AR. Individual serial changes before and after balloon post-dilatation are shown in this figure. In patients with VD‑AR > 17%, 7 deaths (34%) occurred, whereas in patients with VD-AR ≤ 17%, 8 deaths (19%) were observed.

Figure 4. Cumulative frequency curve of the rate of improvement or deterioration of aortic regurgitation by balloon post-dilatation. The formula of the relative delta VD-AR was “(VD-AR after BPD - VD-AR before BPD)/VD-AR before BPD”. Negative values indicate improvements of AR after BPD, whereas positive values stand for deterioration of AR after BPD. Using twenty-fifth percentile of the absolute delta VD-AR, arbitrarily we defined a relative delta of less than -20% as a significant improvement (blue), from -20 to 20% as no change (green), and 20% more as a significant deterioration (orange).

Figure 5. Serial changes of visual aortographic assessment.

Figure 6. Videodensitometric- assessment of aortic regurgitation and Sellers’ grade before and after balloon post-dilatation.