Aims: To critically review the available transcatheter aortic valve implantation techniques and their results, as well as propose recommendations for their use and development. Methods and results: A committee of experts including European Association of Cardio-Thoracic Surgery and European Society of Cardiology representatives met to reach a consensus based on the analysis of the available data obtained with transcatheter aortic valve implantation and their own experience. The evidence suggests that this technique is feasible and provides haemodynamic and clinical improvement for up to 2 years in patients with severe symptomatic aortic stenosis at high risk or with contraindications for surgery. Questions remain mainly concerning safety and long-term durability, which have to be assessed. Surgeons and cardiologists working as a team should select candidates, perform the Procedure, and assess the results. Today, the use of this technique should be restricted to high-risk patients or those with contraindication for surgery. However, this may be extended to lower risk patients if the initial promise holds to be true after careful evaluation. Conclusion: Transcatheter aortic valve implantation is a promising technique, which may offer an alternative to conventional surgery for high-risk patients with aortic stenosis. Totiay, careful evaluation is needed to avoid the risk of uncontrolled diffusion.

Transcatheter Valve Implantation for Patients with Aortic Stenosis : a position statement from the European Association of Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI)

The choice of preferred access route for transcatheter aortic valve implantation (TAVI) is mainly guided by the minimal aorto-femoral tract diameter. Currently, projection angiography (XA) and CT-angiography (CTA) are used interchangeably to assess this diameter in the TAVI work-up. We aimed to assess the agreement of XA and CTA diameter measurements in TAVI candidates. Diameters of 700 aorta-iliac segments of 102 TAVI candidates were analyzed on both XA and CTA. The diameters on XA were measured manually, for the CTA-based analysis semi-automated segmentation software was used. Paired sample T test was used to evaluate differences in diameter measurements between the modalities. Disagreement on the suitability for a transfemoral (TF)-TAVI approach was identified. The interobserver agreement for both measurements was assessed by calculating the intraclass correlation coefficient (ICC). The average diameters were 10.1 ± 1.8 mm and 8.4 ± 1.7 for XA and CTA respectively. The mean paired difference was 1.73 mm (p < 0.001). For 18 patients (17.6 %) diameters measured on CTA images, were bilaterally less than 6 mm, whilst XA indicated a minimum diameter exceeding 6 mm. For both modalities, the interobserver agreement was excellent (ICC 0.95). Diameters measured semi-automatically on CTA were statistically significantly smaller compared to XA. This should be acknowledged in the work-up for selecting the most appropriate approach for TAVI. In our population 17.6 % of patients would have been denied a transfemoral TAVI based on CTA measurements, whilst XA suggested diameters sufficient for a TF approach.

Imaging for approach selection of TAVI: assessment of the aorto-iliac tract diameter by computed tomography-angiography versus projection angiography

Background Transcatheter pulmonary valve implantation (TPVI) with the Melody® transcatheter pulmonary valve (TPV) has demonstrated good haemodynamic and clinical outcomes in the treatment of right ventricular outflow tract (RVOT) conduit dysfunction in patients with repaired congenital heart disease CHD. We present the first Australian single centre experience of patients treated with Melody TPV. Method A prospective, observational registry was developed to monitor clinical and haemodynamic outcomes in patients with RVOT dysfunction treated with the Melody TPV (Medtronic Inc, Minneapolis, United States). Results Seventeen patients underwent TPVI with Melody TPV at The Prince Charles Hospital between January 2009 and February 2016 with a median (range) age of 34 (R: 15–60). Fifteen (88%) were NYHA Class 2 dyspnoea and 11 (59%) had corrected Tetralogy of Fallot. Indication for TPVI was stenosis in eight (47%), regurgitation in two (12%) and mixed dysfunction in seven (41%). Device implantation was successful in all patients. Peak RVOT gradient was significantly reduced and there was no significant regurgitation post procedure. There was one (6%) major procedural adverse event and two (12%) major adverse events at last recorded follow-up. There were no patient deaths. Follow-up cardiac magnetic resonance imaging revealed a significant reduction in indexed right ventricular end diastolic volume. Conclusion This study confirms the safety and effectiveness of TPVI with Melody TPV for RVOT dysfunction in repaired CHD.

https://espace.library.uq.edu.au/view/UQ:475181/UQ475181_OA.pdf

Outcomes Following Melody Transcatheter Pulmonary Valve Implantation for Right Ventricular Outflow Tract Dysfunction in Repaired Congenital Heart Disease: First Reported Australian Single Centre Experience.

Introduccion Los pacientes con estenosis aortica (EAo) severa sintomatica deberian someterse a cirugia de sustitucion valvular aortica, porque el desarrollo de sintomas es un marcador de mal pronostico Sin embargo, hasta un tercio de estos enfermos no se operan por presentar un elevado riesgo quirurgico Recientemente, se ha introducido la implantacion de protesis aorticas transcateter (TAVI) como una alternativa terapeutica para este grupo de pacientes Para lograr resultados optimos en los procedimientos de TAVI, son necesarios tanto la seleccion adecuada de los candidatos como un riguroso estudio de imagen, que actualmente se suele realizar con tomografia computarizada multidetector (TCMD) En particular, la caracterizacion anatomica exhaustiva del anillo aortico y de su grado de calcificacion son de fundamental importancia Hipotesis La TCMD es util para predecir el riesgo de regurgitacion periprotesica (RP) post-TAVI y para estudiar eficazmente y con seguridad el subgrupo de pacientes candidatos a TAVI que presenten insuficiencia renal significativa Asimismo, la angiografia rotacional tridimensional (AR3D) proporciona informacion similar a la TCMD para el estudio de la raiz aortica en candidatos a TAVI Objetivos Realizar la validacion anatomica y establecer la utilidad clinica de la TCMD en el tratamiento de la EAo severa mediante TAVI Los objetivos especificos son: 1 Validacion de la TCMD para el estudio del anillo aortico y de las otras estructuras de la raiz aortica importantes para TAVI, y para la caracterizacion de la calcificacion valvular aortica, tomando como referencia el estudio patologico en necropsias 2 Determinar la utilidad clinica de tres nuevas estrategias en el estudio de imagen con TCMD, para optimizar los resultados de la TAVI Se analizaran tres series de pacientes para responder a tres preguntas clinicas: • Serie I: Valorar la utilidad de la AR3D como complemento a la TCMD en el estudio pre-TAVI de la raiz aortica y como ayuda al procedimiento • Serie II: Explorar el papel de la calcificacion valvular aortica en el desarrollo de RP post-TAVI, proponer una nueva variable que incluya informacion sobre la carga total de calcificacion valvular aortica y sobre su aglomeracion en forma de grandes nodulos, y valorar si este nuevo parametro es util para predecir el riesgo de RP post-TAVI • Serie III: Optimizar el protocolo de estudio de la aorta y del eje ileo-femoral por TCMD para estudiar eficazmente y con seguridad el subgrupo de pacientes que sean candidatos a TAVI y que tengan insuficiencia renal significativa Resultados y Conclusiones Las medidas de las estructuras de la raiz aortica, realizadas mediante TCMD, coinciden con gran exactitud con las realizadas en las piezas anatomicas Asimismo, la TCMD demostro ser muy util para identificar y caracterizar la calcificacion valvular aortica Se han evaluado, ademas, tres aplicaciones de la TCMD que podrian contribuir a la optimizacion del procedimiento de TAVI Serie I La AR3D es una tecnica basada en tecnologia de TC que proporciona medidas fiables de las estructuras anatomicas por encima del anillo aortico Sin embargo, la variabilidad interobservador en las medidas del anillo aortico, asi como otras limitaciones logistico-tecnicas, no permiten actualmente su utilizacion como sustituto de la TCMD Serie II La calcificacion valvular aortica es un importante determinante del desarrollo de RP Tanto la carga global de calcio como su aglomeracion en forma de grandes nodulos influencian el desarrollo de RP El Aortic Valve Calcium Nodule Score (AVCNS) permite cuantificar a la vez estos dos importantes aspectos y demostro ser un predictor independiente de RP tras TAVI Serie III Una adaptacion cuidadosa del protocolo de TCMD pre-TAVI con un equipo de ultima generacion permitio la realizacion de esta tecnica utilizando cantidades minimas de contraste y preservando la calidad de las imagenes Este protocolo puede ser util en pacientes con insuficiencia renal avanzada, que habitualmente no son sometidos a TCMD por el riesgo de nefropatia por contraste

/pdf/validacion-anatomica-y-utilidad-clinica-de-la-tomografia-1567y7pyzp.pdf

Validación anatómica y utilidad clínica de la tomografía computarizada multidetector para optimizar el tratamiento percutáneo de la estenosis aórtica severa mediante prótesis biológica transcatéter

Three-dimensional rotational angiography (3D-RA) is routinely used in many different medical fields including neurovascular treatments and electrophysiological procedures. With the advent of transcatheter valve implantation and extensive aortic repair, 3D-RA has evolved to be an additional valuable imaging tool to optimize procedural success in endovascular treatment and cardiothoracic surgery.

Three-Dimensional Rotational Angiography

Adequate vascular access for femoral trans-catheter aortic valve replacement is fundamental to the success of the procedure. Assessment of vascular calibre, tortuosity and calcification is performed by angiography and multi-slice computed tomography (MSCT). Can DynaCT provide the same information as MSCT? 15 Patients underwent MSCT, angiography and DynaCT. Vessel diameter measurements were taken in three positions of the left and right ilio-femoral arteries. Tortuosity was assessed using an index of the direct distance and the distance taken by the artery between two points. Calcification was assessed in MSCT and DynaCT using a simple scoring system. Concordance correlation coefficient of arterial calibre between angiography and MSCT was 0.96 (95 % CI 0.94-0.97). DynaCT and angiography was 0.94 (95 % CI 0.91-0.96) and Dyna CT and MSCT, 0.95 (95 % CI 0.92-0.97). Bland-Altman tests demonstrate a mean difference between the angiogram and the MSCT of 0.06 mm (+0.97, -1.42), angiogram and DynaCT, 0.13 mm, (+1.00, -0.87), DynaCT and MSCT, 0.2 mm, (+1.15, -0.76). Tortuosity comparisons gave a median tortuosity index for MSCT 1.29 and DynaCT 1.23 (p = 0.472). Calcification comparisons of MSCT and DynaCT using correlation coefficients demonstrate a correlation of 0.245 (p = 0.378). Effective radiation doses were: DynaCT; 3.63 ± 0.65 mSv and angiography; 0.57 ± 0.72 mSv, MSCT; 7.15 ± 2.58 mSv. DynaCT is equal to MSCT and angiography in assessing femoral artery calibre. Like MSCT, it can assess tortuosity and can produce 3D images but is inferior in the assessment of calcification.

Using DynaCT for the assessment of ilio-femoral arterial calibre, calcification and tortuosity index in patients selected for trans-catheter aortic valve replacement

A patient with a medial and posterior dislocation of the right sterno-clavicular (SC) joint and displacement of the trachea and brachiocephalic artery by the medial head of the clavicle underwent general anaesthetic in the operating theatre for an open reduction procedure. The surgeon initially attempted a closed reduction, but this required imaging to check SC alignment. The patient was transferred to an adjacent hybrid operating theatre for imaging. Cone beam computed tomography (CBCT) was performed, which successfully demonstrated a significant reduction in the dislocation of the SC joint. The trachea and brachiocephalic artery were no longer compressed or displaced. This case study demonstrates an alternative to the patient being transferred to the medical imaging department for multi-slice CT. It also describes a novel use of the hybrid operating theatre and its CBCT capabilities.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/jmrs.15

Novel utilization of 3D technology and the hybrid operating theatre: Peri‐operative assessment of posterior sterno‐clavicular dislocation using cone beam CT

Handle everyday research tasks with reliable, citation-backed results

Your personal Research Agent to handle research tasks with citation-backed results

Popular Tasks used by Researchers

How can I help with your research?

Meet SciSpace

Get more enhanced response by uploading the PDFs you want me to reference.

No relevant PDFs in your library

SciSpace is the AI research assistant for academics. Run systematic literature reviews on 280M+ papers, and write papers with cited sources. Trusted by 1M+ students, PhDs & researchers.

SciSpace | AI for Research

Analyze PDFs

Code & Manuscripts

Funding & Grants

Literature & Patents

Medical & Clinical Data

Systematic Review

Visualize & Present

Web & Data

Build a Google Scholar-like website for your research.

Build a website

Create charts and images for your research

Create a Chart

Write a paper for submission to a journal

Draft a manuscript

Patent Search

Design eye-catching scientific posters in minutes.

Scientific Poster Generation

Systematic Literature Review

One task is running at the moment. Your messages will be shown right after.

Drag and drop or click here to browse

Loved by <highlight>1 million+</highlight> researchers

Extract a list of specific topics and their sources from unstructured text

Topics

Compare and analyze relevant papers that matches with your search

Papers

Get insights from PDFs and bookmarked papers from your library

My library

Recent searches

Try searching for:

Catch AI-generated content in scholarly and non-scholarly content

{ai} Detector

Ai Writer

Get PDF Summaries, highlighted text explanations 

Chat with PDF

Effortlessly create in-text citations and bibliographies in APA and 2,500 other formats

Citation generator

Get explanations, summaries, and answers on academic papers

Ease up your research workflow with {scispace}'s cohort of exciting AI tools

Elevate your academic writing skills and convey your ideas the way you want

Paraphraser

Explore our range of reading and writing tools

Your file is being prepared and should be ready in a few minutes. If it's a large file, it might take a bit longer. You can close this window, and we'll email you the file when it's done.

You have reached a maximum limit of <strong>{limit}</strong> columns in the table. Remove at least <strong>1</strong> column to add or create another one.

Pavthrun Pathmanathan

Author Tools

Chat about Author

Papers

Using DynaCT for the assessment of ilio-femoral arterial calibre, calcification and tortuosity index in patients selected for trans-catheter aortic valve replacement

Novel utilization of 3D technology and the hybrid operating theatre: Peri‐operative assessment of posterior sterno‐clavicular dislocation using cone beam CT