TAVR Aortic Root Measurements

Purpose	Automate aortic root and cardiac measurements for transcatheter aortic valve replacement (TAVR) necessary to determine the size and type of valve best for the patient.
Tag(s)
Panel	Cardiac
Define-AI ID	18040023
Originator	Kimberly Brockenbrough
Panel Chair	Carlo De Cecco
Panel Reviewers	Cardiac Panel
License	Creative Commons 4.0
Status	Published

Clinical Implementation

Value Proposition

Measurements of the aortic root are essential for determining the appropriate size of a prosthetic aortic valve. Inappropriate sizing can result in aortic rupture or perivalvular leak. These measurements are now performed by radiologists and/or a dedicated 3D lab. Obtaining these measurements is time consuming, with times ranging from 45 to 90 minutes. Gated CT angiography (CTA) of the chest is the best method for obtaining the images.

Narrative(s)

An 83-year-old woman presents with dyspnea and increased exercise intolerance. An echocardiogram shows that she has severe aortic stenosis. The patient is determined to be a high-risk candidate for surgery. A CTA of the chest, abdomen, and pelvis is performed to determine the size of the aortic root and determine the best access for deployment of an aortic valve.

Workflow Description

A patient receives ECG-synchronized CTA of the chest. An algorithm retrieves input for an imaging data set and relevant electronic medical record data, including age, gender, and body surface area (BSA; mL/m2). The algorithm determines the best single diastolic and single systolic phases of CT with the least motion artifact and then performs measurements, defined below, on both diastolic and systolic phases. At the aortic annulus, the algorithm measures the minimum and maximum diameters and the area and perimeter. At the maximum diameter of the sinuses of Valsalva, the algorithm measures the minimum and maximum diameters and the area and perimeter. At 15 mm above the annulus at the sinuses of Valsalva, the algorithm measures the minimum and maximum diameters and the area and perimeter. At the sinotubular junction, the algorithm measures the minimum and maximum diameter. The algorithm determines the coronary heights of the right coronary and left main coronary arteries. The algorithm also determines the sinotubular height, calculates the calcium score of the aortic valve, determines the best angle of entry, and determines if the thoracic aorta is aneurysmal based on the gender, BSA, and age of the patient. The algorithm returns all measurements and recommends valve size for the patient for each available vendor.

Considerations for Dataset Development

Procedures(s): Gated CTA of the chest

View(s): CCTA: Any volumetric imaging data set

Sex at Birth: {Male, Female}

Age: [18,70]

History: Severe Aortic stenosis

CT: Must be gated with multiple diastolic and systolic phases of the cardiac cycle

Contrast Material: {CT w/ IV arterial-phase contrast, w/o arterial-phase contrast}

Position: {Weight bearing, nonweight bearing}

Technical Specifications

Inputs

DICOM Study

Procedure	Gated CTA, Chest
Views	CCTA: Any volumetric imaging data set
Data Type	DICOM
Modality	CTA
Body Region	Chest
Anatomic Focus	Heart

Primary Outputs

Best Systolic Phase

RadElementID	RDE17
Definition	Systolic phase with the least motion artifact
Data Type	Numeric
Value Set	[0,100]
Units	Percentage of cardiac cycle in systole

Best Diastolic Phase

RadElementID	RDE318
Definition	Diastolic phase with the least motion artifact
Data Type	Numeric
Value Set	[0,100]
Units	Percentage of cardiac cycle in diastole

Aortic Annulus Maximum Diameter in Systole

RadElementID	RDE319
Definition	Aortic annulus maximum diameter
Data Type	Numeric
Value Set
Units	mm

Aortic Annulus Minimum Diameter in Systole

RadElementID	RDE320
Definition	Aortic annulus minimum diameter
Data Type	Numeric
Value Set
Units	mm

Aortic Annulus Perimeter in Systole

RadElementID	RDE321
Definition	Aortic annulus perimeter
Data Type	Numeric
Value Set
Units	mm

Aortic Annulus Area

RadElementID	RDE322
Definition	Aortic annulus area
Data Type	Numeric
Value Set
Units	mm²

LVOT 3 mm Below the Annulus Minimum Diameter in Systole

RadElementID	RDE323
Definition	Left ventricular outflow tract (LVOT) 3 mm below the annulus minimum diameter
Data Type	Numeric
Value Set
Units	mm

LVOT 3 mm Below the Annulus Maximum Diameter in Systole

RadElementID	RDE324
Definition	Left ventricular outflow tract (LVOT) 3 mm below the annulus maximum diameter
Data Type	Numeric
Value Set
Units	mm

LVOT 3 mm Below the Annulus Perimeter in Systole

RadElementID	RDE325
Definition	Left ventricular outflow tract (LVOT) 3 mm below the annulus perimeter
Data Type	Numeric
Value Set
Units	mm

LVOT 3 mm Below the Annulus Area in Systole

RadElementID	RDE3 26
Definition	Left ventricular outflow tract (LVOT) 3 mm below the annulus area
Data Type	Numeric
Value Set
Units	mm²

Aortic Annulus Maximum Diameter in Diastole

RadElementID	<not yet defined>
Definition	Aortic annulus maximum diameter
Data Type	Numeric
Value Set
Units	mm

Aortic Annulus Minimum Diameter in Diastole

RadElementID	<not yet defined>
Definition	Aortic annulus minimum diameter
Data Type	Numeric
Value Set
Units	mm

Aortic Annulus Perimeter in Diastole

RadElementID	<not yet defined>
Definition	Aortic annulus perimeter
Data Type	Numeric
Value Set
Units	mm

Aortic Annulus Area in Diastole

RadElementID	<not yet defined>
Definition	Aortic annulus area
Data Type	Numeric
Value Set
Units	mm²

LVOT 3 mm Below the Annulus Minimum Diameter in Diastole

RadElementID	<not yet defined>
Definition	Left ventricular outflow tract (LVOT) 3 mm below the annulus minimum diameter
Data Type	Numeric
Value Set
Units	mm

LVOT 3 mm Below the Annulus Maximum Diameter in Diastole

RadElementID	<not yet defined>
Definition	Left ventricular outflow tract (LVOT) 3 mm below the annulus maximum diameter
Data Type	Numeric
Value Set
Units	mm

LVOT 3 mm Below the Annulus Perimeter in Diastole

RadElementID	<not yet defined>
Definition	Left ventricular outflow tract (LVOT) 3 mm below the annulus perimeter
Data Type	Numeric
Value Set
Units	mm

LVOT 3 mm Below the Annulus Area in Diastole

RadElementID	<not yet defined>
Definition	Left ventricular outflow tract (LVOT) 3 mm below the annulus area
Data Type	Numeric
Value Set
Units	mm²

Sinotubular Junction Minimum Diameter in Systole

RadElementID	RDE327
Definition	Sinotubular junction minimum diameter
Data Type	Numeric
Value Set
Units	mm

Sinotubular Junction Maximum Diameter in Diastole

RadElementID	RDE328
Definition	Sinotubular junction maximum diameter
Data Type	Numeric
Value Set
Units	mm

Right Coronary Height Minimum

RadElementID	RDE329
Definition	Height from aortic annulus to bottom of the right coronary artery origin
Data Type	Numeric
Value Set
Units	mm

Right Coronary Height Maximum

RadElementID	RDE330
Definition	Height from aortic annulus to top of the right coronary artery origin
Data Type	Numeric
Value Set
Units	mm

Left Coronary Height Minimum

RadElementID	RDE331
Definition	Height from aortic annulus to bottom of the left coronary artery origin
Data Type	Numeric
Value Set
Units	mm

Left Coronary Height Maximum

RadElementID	RDE332
Definition	Height from the aortic annulus to the top of the left coronary artery origin
Data Type	Numeric
Value Set
Units	mm

Aortic Valve Calcium Score

RadElementID	RDE333
Definition	Agatston calcium score of aortic valve
Data Type	Numeric
Value Set
Units	Agatston score

Secondary Outputs

AV Angle in Systole

RadElementID	RDE334
Definition	Aortic valve angle
Data Type	Numeric
Value Set
Units	degrees

Annulus to Apex Curved Length

RadElementID	RDE335
Definition	Distance from aortic annulus to apex of the left ventricle curved in ventricle
Data Type	Numeric
Value Set
Units	mm

Annulus to Apex Straight Length in Systole

RadElementID	RDE336
Definition	Distance from aortic annulus to apex of the left ventricle with a straight line
Data Type	Numeric
Value Set
Units	mm

Left Ventricle Width in Systole

RadElementID	RDE337
Definition	Width of left ventricle in systole
Data Type	Numeric
Value Set
Units	mm

Approximate Deployment Angle

RadElementID	RDE338
Definition	Angle to optimize visualization of the 3 cusps of the aortic valve
Data Type	Numeric
Value Set
Units	degrees

Related Datasets

No known related public datasets at this time, please alert us if you know of any.