Published Online
on May 22, 2009

A more recent version of this article appeared on September 1, 2009

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Original Article

Feasibility of Cardiovascular Magnetic Resonance to Assess the Orifice Area of Aortic Bioprostheses

Florian von Knobelsdorff–Brenkenhoff; André Rudolph; Ralf Wassmuth; Steffen Bohl; Eva E. Buschmann; Hassan Abdel–Aty; Rainer Dietz and Jeanette Schulz–Menger¹

University Medicine Berlin, Charité Campus Buch, Berlin, Germany

¹ E-mail: jeanette.schulz-menger{at}charite.de

Background—Prosthetic orifice area, usually calculated by transthoracic or transesophageal echocardiography (TTE, TEE), provides important information regarding the hemodynamic performance of aortic bioprostheses. However, both TTE and TEE have limitations, so accurate and reproducible determination of the orifice area often remains a challenge. The present study aimed to investigate the feasibility of Cardiovascular Magnetic Resonance (CMR) to assess the orifice areas of aortic bioprostheses.

Methods and Results—CMR planimetry of the orifice area was performed in 65 patients (43/22 stented/stentless prostheses; mean time since implantation 3.1±2.8 years; mean orifice area (TTE) 1.70±0.43cm²; 62 normally functioning prostheses, 2 severe stenoses, 1 severe regurgitation) in an imaging plane perpendicular to the transprosthetic flow using steady-state free-precession cine imaging under breathhold conditions on a 1.5Tesla MR system. CMR results were compared to TTE (continuity equation, n = 65) and TEE (planimetry, n = 31). CMR planimetry was readily feasible in 80.0%, feasible with limitation in 15.4% due to stent, flow and sternal wire artifacts, and impossible in 4.6% due to flow artifacts. Correlations of the orifice areas by CMR with TTE (r=0.82) and CMR with TEE (r=0.92) were significant. Average difference between the methods was -0.02±0.24cm² (TTE) and 0.05±0.15cm² (TEE). Agreement was present for stented and stentless devices and independent from orifice size. Intra- and inter-observer variability of CMR planimetry were 6.7±5.4% and 11.5±7.8%.

Conclusions—The assessment of aortic bioprostheses with normal orifice areas by CMR is technically feasible and provides orifice areas with close correlation to echocardiography and low observer dependency.

Key Words: echocardiography • imaging • magnetic resonance imaging • surgery • valves