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J Thorac Cardiovasc Surg 2005;130:41-47
© 2005 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Three-dimensional in vivo characterization of calcification in native valves and in Freestyle versus homograft aortic valves

^a Academic Department of Cardiothoracic Surgery, National Heart and Lung Institute, Imperial College, University of London, London, United Kingdom
^b Royal Society/Wolfson Foundation Medical Image Computing Laboratory, London, United Kingdom

Received for publication December 5, 2004; revisions received January 28, 2005; accepted for publication February 10, 2005.

^_* Address for reprints: Professor Magdi Yacoub, The Magdi Yacoub Institute, Harefield Research Foundation, Hill End Rd, Harefield, Middlesex UB9 6JH, United Kingdom (Email: m.yacoub{at}imperial.ac.uk).

OBJECTIVE: This article describes a novel interactive method for quantitative evaluation of calcium deposits in the aortic valve by means of electron beam tomography data fusion technique.

METHODS: The technique relied on the use of hierarchic 3-dimensional free-form volume registration with fast global optimization between normally acquired and contrast-enhanced electron beam tomographic volume. A total of 66 contrast-enhanced electron beam tomographic scans of the aortic root were performed in 27 patients, 10 with native aortic valve disease (group A) and 17 from a prospective randomized trial of aortic root replacement (group B, 9 Freestyle grafts [Medtronic, Inc, Minneapolis, Minn] and 8 homografts). To validate the in vivo electron beam tomographic measurements, 5 patients from group A underwent electron beam tomographic scans before the operation and then had their own valves, explanted at the time of surgery, analyzed for calcium quantification by ex vivo electron beam tomography.

RESULTS: In group A, the mean (± SE) calcification score was 6560 ± 2388, which correlated with peak gradients measured at echocardiography (r = 0.93, P = .02). In group B, the mean (± SE) calcification score was 168 ± 27, showing a tendency toward a lower calcification for Freestyle valves than for homografts at 2 years after implantation (P = .052). A mean variability of 6% was found between in vivo electron beam tomographic scores of calcification and those measured on valve specimens after explantation.

CONCLUSION: We describe a novel method to characterize the degree and location of calcification in both native valves and postoperative valve implants. The technique may be useful in the management of patients with aortic valve disease and has potential as a screening tool for high-risk patients to diagnose early valve calcification and possibly institute corrective measures.

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