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Valve sizing for pure aortic regurgitation (AR) underwent trans-catheter aortic valve implantation (TAVI) - Deep insight into deformation dynamic of aortic annulus in pure AR
Simeng Wang, Wei Cheng, Da Zhu, Yingqiang Guo.
West China hospital of Sichuan University, Chengdu, China.

OBJECTIVE: Indication of TAVI has been expended as for high-risk patient with pure aortic regurgitation (AR). Understanding dynamic aspects of functional aortic valve anatomy is important for this type of beating-heart procedure. Unlike aortic stenosis, the dynamic aspect of aortic annulus in pure AR may quite different. The purpose of this study was to assess deformation dynamics of the aortic annulus throughout the cardiac cycle as for patient with pure AR.
METHODS: During study period, fifteen high-risk patients (mean age 74.2 ± 5.2 years, 5 female) underwent TAVI procedure due to non-calcified pure AR in our institution. All patients received dual-source three-dimensional computed tomography. The aortic annulus plane “Virtual ring” was reconstructed in 10% increments over the cardiac cycle. For each phase, minimum diameter, maximum diameter, cross-sectional area, and perimeter were measured.
RESULTS: As for patient with pure AR, the maximum diameter of the aortic annulus significantly increased in systole phase compared with diastolic phase (2.83±0.42 vs 2.51±0.41cm, P<0.05) while the minimum diameter remained consistent during cardiac cycle (2.24±0.12 vs 2.0±0.31cm,P=0.11). However, both the cross-sectional area and the perimeter were significantly larger in systolic phase than in diastolic phase (4.99±0.21 vs 4.01±0.40cm2, 7.99±0.79 vs 7.41±0.60cm P<0.05) which was quite different from patients with aortic stenosis reported in literature. In some cases, the functional aortic valve annulus even became irregular shape during diastolic phase (Figure 1).
CONCLUSIONS: In contrast to aortic stenosis, deformation dynamic of the aortic valve annulus may be totally different in patient with pure AR. Caution should be applied to annular sizing in patients with pure AR underwent TAVI procedure

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