Influence of Cardiac Phase on Valve-to-Coronary Ostia Distance in Valve-in-Valve Transcatheter Aortic Valve Replacement.

Authors

Farah Cadour, Felipe Castillo, Mini Pakkal, Felipe Soares Torres, Jaydeep Halankar

Published in

Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes. Pages 8465371261496202. Oct 30, 2026. Epub Oct 30, 2026.

Abstract

No consensus exists on which cardiac phase to use for virtual valve-to-coronary ostium (VTC) distance measurement to predict risk of coronary obstruction in valve-in-valve (ViV). Our study aimed to investigate whether cardiac phase influences VTC measurements in ViV for failing stented surgical heart valves (SHV).
All adult patients with stented SHV referred for a pre-planning CT for ViV between 2020 and 2025 were retrospectively eligible. For each patient, VTC was measured for two transcatheter heart valve options at both the right and left coronary ostia. VTC measurements were compared between systole, diastole, and phase with best image quality (best phase). Prevalence of changes in coronary obstruction risk (based on 4-mm cutoff) depending on the phase was assessed. Inter- and intraobserver reliability was evaluated.
A total of 398 VTC measurements derived from 116 included patients (69 male, 71 ± 13 years) were evaluated. Best phase was more often diastolic. Median VTCs differed between systole and diastole (P < .001), and systole and best phase (P < .001), but not between diastole and best phase (P = .47) (systole 4.8 [3.1-6.5] mm vs diastole 4.6 [3.1-6.2] mm vs best phase 3.9 [2.5-6.2] mm). Measurements were slightly higher in systole than in diastole (mean difference +0.24 mm, [95% CI: 0.16, 0.32]; P < .001), but similar between diastole and best phase (P = .47). Risk of coronary obstruction changed between systole and diastole in 41 coronary arteries (41/398, 10%). Intra- and interobserver reliability was good-to-excellent.
VTC measurements differed and were slightly higher in systole than in diastole, which may influence the coronary obstruction risk classification.

PMID:
42958885
Bibliographic data and abstract were imported from PubMed on 30 Oct 2026.

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