Videodensitometric quantification of paravalvular regurgitation of a transcatheter aortic valve: in vitro validation.

M. Abdelghani, Y. Miyazaki, E.S. de Boer, J.P. Aben, M. van Sloun, T. Suchecki, M. van 't Veer, O.I.I. Soliman, Y. Onuma, R. de Winter, P. Tonino, F.N. van de Vosse, M.C.M. Rutten, P.W. Serruys

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Aims: Videodensitometric assessment of aortography provides a periprocedural quantitation of prosthetic valve regurgitation (PVR) after transcatheter aortic valve implantation. We sought to compare the videodensitometric parameters of PVR severity to the regurgitation fraction (RF) in a controlled in vitro setting. Methods and results: In a mock circulation system, a transcatheter balloon-expandable valve inserted at the aortic valve position was gradually deformed to induce different grades of paravalvular leakage and the RF was measured with a transonic flow probe. Contrast aortography was performed and the following videodensitometric parameters were generated: left ventricle aortic regurgitation (LV-AR), LV outflow tract AR (LVOT-AR), quantitative regurgitation assessment (qRA) index, relative maximum density (relative max), and maximum upslope of the LV time-density curve. The correlation was substantial between videodensitometric parameters (LV-AR, LVOT-AR, qRA index, relative max, and maximum upslope) and RF (r 2=0.96, 0.96, 0.93, 0.87, and 0.93; p<0.001 for all). LV-AR (region of interest [ROI]=entire LV) and LVOT-AR (ROI=LVOT) were not different (p=0.51) and were strongly correlated (r 2=0.99) with a mean difference of 1.92% (95% limits of agreement: ±2.83). The correlations of LV-AR and LVOT-AR with RF were stronger when more than one cardiac cycle was included in the analysis (one cycle: r 2=0.85 and r 2=0.83; four cycles: r 2=0.96 and r 2=0.96, for LV-AR and LVOT-AR, respectively). Including more cycles beyond four did not improve accuracy. Conclusions: Quantitative assessment of PVR by videodensitometry of aortograms strongly correlates with the actual RF in a controlled in vitro setting. Accuracy is improved by including more than one cardiac cycle in the analysis.

Original languageEnglish
Pages (from-to)1527-1535
Number of pages9
Issue number13
Publication statusPublished - 20 Jan 2018


  • aortic stenosis
  • imaging modalities
  • paravalvular leak
  • transcatheter aortic valve implantation (TAVI)
  • Severity of Illness Index
  • Predictive Value of Tests
  • Models, Cardiovascular
  • Humans
  • Transcatheter Aortic Valve Replacement/adverse effects
  • Prosthesis Design
  • Heart Valve Prosthesis/adverse effects
  • Densitometry
  • Hemodynamics
  • Aortography/methods
  • Aortic Valve Insufficiency/diagnostic imaging
  • Aortic Valve/diagnostic imaging
  • Radiographic Image Interpretation, Computer-Assisted/methods
  • Models, Anatomic


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