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Computed tomography for planning and postoperative imaging of transvenous mitral annuloplasty: first experience in an animal model
Simon Sündermann1, Sonja Gordic2, Robert Manka3, Nikola Cesarovic4, Hatem Alkadhi2, Volkmar Falk1, Francesco Maisano1.
1Division of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland, 2Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland, 3Clinic of Cardiology, University Hospital Zurich, Zurich, Switzerland, 4Department of Surgical Research, University Hospital Zurich, Zurich, Switzerland.
OBJECTIVE: To investigate the use of computed tomography (CT) to measure the mitral valve annulus size before implantation of a percutaneous mitral valve annuloplasty device in an animal trial.
METHODS: Five domestic pigs were included. Under general anesthesia animals underwent CT before and after the implantation of a Cardioband™ (percutaneously implantable mitral valve annuloplasty device) with a second-generation 128-section dual-source CT machine. Posterior mitral annular circumference, shortest distance from posterior annular circumference to the circumflex artery were measured before and device length and shortest distance from anchor to RCx were measured after the implantation of the Cardioband™. After sacrifice of the animals, the hearts were explanted and the length of the Cardioband™ was measured manually.
RESULTS: Implantation of the CardioBand™ could be performed successfully. Gross examination found the CardioBand™ adequately implanted in all animals, with no anchor dehiscence and no damage of the circumflex artery. The CardioBand™ device did not result in a metal artifact-related degradation of image quality in any of the animals. Both the implant and the surrounding structures could be visualized on postinterventional CT with high quality and measurements of the length of the CardioBand™ could be successfully performed. The average posterior mitral annular circumference prior to intervention measured 99.5 ± 3.8 mm, the average length of the CardioBand™ measured in CT after intervention was 86.9 ± 9.3 mm, and direct measurements after explantation revealed an average length of the implant of 97.2 ± 6.1 mm. The distance from the posterior mitral annulus to the CX was 3.0 ± 0.9 mm (range 3 - 5 mm). The closest distance from the closest anchor to the CX was 2.0 ± 0.8 mm (range 1 - 3 mm).
CONCLUSIONS: CT visualization and measurement of the mitral valve annulus dimensions is feasible and could become the imaging method of choice for procedure planning before implantation of a CardioBand™ or other transcatheter mitral annuloplasty devices that are already available or will be available in the future.
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