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 | |
| 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 | |
| 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 | |
| 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 | |
| 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 | |
| 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 | |
| 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 | |
| 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 | |
| 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 | |
| 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 | |
| Definition | Agatston calcium score of aortic valve |
| Data Type | Numeric |
| Value Set |
|
| Units | Agatston score |
Secondary Outputs
AV Angle in Systole
| RadElementID | |
| Definition | Aortic valve angle |
| Data Type | Numeric |
| Value Set |
|
| Units | degrees |
Annulus to Apex Curved Length
| RadElementID | |
| 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 | |
| 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 | |
| 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.