AIMS To investigate valve sizing and the haemodynamic relevance of the predicted left ventricular outflow tract (LVOT) in patients with mitral annular calcification (MAC) undergoing transatrial transcatheter valve implantation (THV). METHODS AND RESULTS In total, 21 patients undergoing transatrial THV, multiplanar reconstruction (MPR), maximum intensity projection (MIP), and cubic spline interpolation (CSI) were compared for MA sizing during diastole. In addition, predicted neo-LVOT areas were measured in 18 patients and correlated with the post-procedural haemodynamic dimensions. The procedure was successful in all patients (100%). Concomitant aortic valve replacement was performed in eight patients (43%) (AVR group). Sizing using MPR and MIP yielded comparable results in terms of area, perimeter, and diameter, whereas the dimensions obtained with CSI were systematically smaller. The simulated mean systolic neo-LVOT area was 133.4 ± 64.2 mm2 with an anticipated relative LVOT area reduction (neo-LVOT area/LVOT area × 100) of 59.3 ± 14.7%. The systolic relative LVOT area reduction, but not the absolute neo-LVOT area, was found to predict the peak (r = 0.69; P = 0.002) and mean (r = 0.65; P = 0.004) post-operative aortic gradient in the overall population as well as separately in the AVR (peak: r = 0.91; P = 0.002/mean: r = 0.85; P = 0.002) and no-AVR (peak: r = 0.89; P = 0.003/mean: r = 0.72; P = 0.008) groups. CONCLUSION In patients with severe MAC undergoing transatrial transcatheter valve implantation, MPR, and MIP yielded comparable annular dimensions, while values obtained with CSI tended to be systematically smaller. Mitral annular area and the average annular diameter appear to be reliable parameters for valve selection. Simulated relative LVOT reduction was found to predict the post-procedural aortic gradients.

中文翻译：

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严重二尖瓣环钙化患者的影像学：使用心房球囊扩张式瓣膜置换术从多中心经验中获得的见解。

目的探讨二尖瓣环钙化（MAC）患者行经房导管切开术（THV）的二尖瓣环钙化（MAC）患者的瓣膜大小和血流动力学相关性。方法与结果总共比较了21例行经心房THV，多平面重建（MPR），最大强度投影（MIP）和立方样条插值（CSI）的患者在舒张期的MA大小。此外，在18例患者中测量了预测的新LVOT面积，并与术后血流动力学尺寸相关。该过程在所有患者中均成功（100％）。八名患者（43％）（AVR组）同时进行了主动脉瓣置换术。使用MPR和MIP进行尺寸调整后，可在面积，周长和直径方面取得可比的结果，而使用CSI获得的尺寸在系统上较小。模拟的平均收缩期neo-LVOT面积为133.4±64.2 mm2，预计相对LVOT面积减少量（neo-LVOT面积/ LVOT面积×100）为59.3±14.7％。发现收缩期相对LVOT面积减少而非绝对新LVOT面积可预测总体主动脉梯度的峰值（r = 0.69; P = 0.002）和平均值（r = 0.65; P = 0.004）。人口以及在AVR中分别（峰值：r = 0.91； P = 0.002 /平均值：r = 0.85； P = 0.002）和无AVR（峰值：r = 0.89； P = 0.003 /平均值：r = 0.72；以及P = 0.008）组。结论在患有严重MAC的患者中，经心房导管瓣膜植入术，MPR和MIP可产生可比的环形尺寸，而CSI所获得的值倾向于系统地较小。二尖瓣环面积和平均环直径似乎是选择阀的可靠参数。已发现模拟的相对LVOT降低可以预测术后主动脉梯度。