| Background: Transcatheter aortic valve replacement(TAVR)has become one of the most important methods for the treatment of degenerative aortic stenosis.TAVR has also been used to treat aortic insufficiency.With the maturity of TAVR technology and the accumulation of physician experience,more patients with lower surgical risk and a long-life expectancy may be treated with TAVR.Therefore,for such patients,future transcatheter heart valve(THV)failure or coronary atherosclerotic heart disease will require repeat intervention.If the ridge formed at the valve leaflet junction of the THV obstructs the coronary ostium,it may increase the possibility of obstruction the coronary ostium during repeat TAVR,and the difficulty of engaging the catheters to the ostia of the coronary artery during percutaneous coronary intervention(PCI).There are few reports in China on how to achieve the commissural alignment(CA),so as to avoid obstruction of the coronary artery ostium by the prosthetic valve crest during TAVR.Objective: To evaluate the coronary artery ostium obstruction caused by the commissure of transcatheter heart valve(THV)with the markers on THV under X-ray,which was identified by observing the position relationship between the commissure of THV and the coronary artery ostium from analyzing aortic root computed tomographic angiography(CTA)images after transcatheter aortic valve replacement(TAVR).Methods: A retrospective analysis was performed on 39 patients undergoing TAVR who were checked with electrocardiographically gated CTA for the aortic root after the TAVR procedure between January 2020 and February 2023 in General Hospital of Northern Theater Command.The images of THV with the lowest position of non-coronary sinus and the right anterior oblique and caudal in most cases were observed when the THVs were deployed.The position relationships of the three markers on the THV after valve release were recorded,which were divided into three conditions,namely the three markers being averagely distributed,the middle marker being close to right,and the middle marker being close to left.Postoperative CTA images of the patients were analyzed.The angle between the commissure of THV and the coronary artery ostium was measured.Results: The angles between the markers of THV and the left coronary artery ostium were 23.00(16.00,31.00)°,39.00(26.50,45.00)°,7.00(3.00,25.00)°,respectively,in the markers averagely distributed group(n=15),the middle marker close to left group(n=13)and the middle marker close to right group(n=11),which were significantly different(P <0.05).The angles between the markers of THV and the right coronary artery ostium were38.00±12.02°,45.08±10.75°,20.91±9.05°,respectively,in the markers averagely distributed group,the middle marker close to left group,and the middle marker close to right group,which were significantly different(P <0.05).When the three markers were evenly distributed,the proportion of moderate or above obstruction at the left coronary artery ostium was 4/15(26.7%),and that at the right coronary artery ostium was 11/15(73.3%).When the middle marker was close to the left,the proportion of moderate or above obstruction of the left coronary artery ostium was 9/13(69.2%),and that of the right coronary artery ostium was12/13(92.3%).When the middle marker was close to the right,7/11(63.6%)and 3/11(27.3%)of the left and right coronary artery ostia were unobstructed,respectively.The proportion of moderate or severe obstruction of coronary artery in the group with the middle marker close to the right was smaller than that in the other two groups(The left coronary artery was 9.1%,the right coronary artery was 18.2%,respectively).Compared with the group with the middle marker close to the left,the group with the marker close to the right had a statistically significant difference in the proportion of unobstructed left coronary artery ostium(63.6% vs15.4%,P < 0.05).Compared with the group with the middle marker close to the left,the group with the marker close to the right had a statistically significant difference in the proportion of mild obstruction of the right coronary artery opening(54.5% vs 7.7%,P < 0.05).Conclusions: The degree of coronary artery ostium obstruction by the commissure of THV can be accurately evaluated by using markers on THV.Among them,when the middle marker is close to right,the commissures of THV are least likely to obstruct the coronary artery ostium.When the middle marker is close to left,the commissures of THV are likely to obstruct the coronary artery ostium. |
PDF Full Text Request