Evaluation of the anatomic sinus after transcatheter aortic valve replacement

• Published in: International journal of cardiology 2024-02, Vol.396, p.131551-131551, Article 131551
• Main Authors: Moscarelli, Marco, Prestera, Rosa, Fiore, Corrado, Pernice, Vincenzo, Milo, Sabrina, Violante, Francesco, Cuffari, Federico, Di Pasquale, Claudia, Ferlisi, Angelo, Speziale, Giuseppe, Fattouch, Khalil
• Format: Article
• Language: English
• Subjects: Aortic Valve - diagnostic imaging; Aortic Valve - surgery; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - surgery; Humans; Reproducibility; Reproducibility of Results; Sinus of Valsalva; Subclinical leaflet thrombosis; Transcatheter aortic valve replacement; Transcatheter Aortic Valve Replacement - adverse effects; Transcatheter Aortic Valve Replacement - methods
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2023.131551

Following transcatheter aortic valve replacement (TAVI), the newly formed ‘anatomic sinus’. may contribute to the formation of subclinical leaflet thrombosis (SLT).The evaluation of root geometry after TAVI is generally performed using multi-detector computed tomography (MDCT), and the role of transthoracic echocardiography (2D TTE) requires further validation. Thus, we aimed to test the reproducibility of 2D TTE assessment of the anatomic sinus with MDCT as a reference and its association with SLT. 2D TTE was performed in 90 patients, and the echocardiograms were analyzed offline. Both sinus of Valsalva (SOV) and prosthesis diameters were assessed in the long- and short-axis parasternal views (PLAX/PSAX), and the anatomic sinus area was calculated. Inter- and intra-observer reproducibility were assessed using the interclass correlation coefficient (ICC). MDCT was performed in 50 individuals to evaluate concordance with 2D TTE and to detect SLT. There was excellent correlation regarding the diameter of the SOV and the prosthesis in PLAX (ICC: 0.93 (95% CI: 0.76,0.97); ICC: 0.80 (95% CI: 0.63,0.96)) and PSAX view (ICC: 0.90 (95% CI: 0.68,0.97); ICC: 0.88 (95% CI: 0.63,0.96)). Bland–Altman analysis of 2D TTE and MDCT anatomic sinus areas indicated a high level of agreement. SLT was detected in 8 individuals (16%); 3 patients had severe SLT at the level of 1 cusp. 2D TTE might play a role in the evaluation of the anatomic sinus after TAVI. The importance of this space and its effects on the SLT remain uncertain. [Display omitted] •Following TAVI, a newly space (named ‘anatomic sinus’) is created in the Valsalva.•We conducted a study to evaluate reproducibility of anatomic sinus 2D TTE measure.•Multi detector CT scans were used as reference in 50 patients.•We demonstrated good interobserver correlation of anatomic sinus 2D TTE measures.•The 2D TTE might have a role in the evaluation of the anatomic sinus after TAVI.