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. 2024 Sep 4;11(9):275.
doi: 10.3390/jcdd11090275.

Assessment of the Aorto-Septal Angle Post-Thoracic Endovascular Aortic Repair through Segmentation and the Semi-Automatic Analysis of Cardiosynchronized Computed Tomography Angiography Images

Marco Magliocco  1 , Michele Conti  2   3 , Bianca Pane  4   5 , Marco Canepa  1   6 , Sara Seitun  7 , Simone Morganti  8 , Giovanni Pratesi  4   5 , Giovanni Spinella  4   5
Affiliations

Assessment of the Aorto-Septal Angle Post-Thoracic Endovascular Aortic Repair through Segmentation and the Semi-Automatic Analysis of Cardiosynchronized Computed Tomography Angiography Images

Marco Magliocco et al. J Cardiovasc Dev Dis. .

Abstract

The aim of this study was to inviestigate cardiac and arterial remodelling before and after thoracic endovascular aortic repair (TEVAR) by measuring the Aorto-Septal Angle (AoSA) and the geometric characteristics of the aorta. Five patients were prospectively included. Pre- and post-operative cardio-CTA scans were used to create patient-specific 3D models to calculate the AoSA, defined by the intersection of the aortic and left ventricular axes. Additionally, geometric parameters and the inclination of the ascending aorta (AA) were measured. The results demonstrated a variation between pre- and post-operative AoSA in all patients, with an increase in the case of an aneurysmal disease from 112.36° ± 8.21° to 117.16° ± 9.65° (+4.1%, p = 0.041) and a decrease in the case of aortic dissection from 113.62° ± 0.96° to 107.83° ± 1.45° (-5.1%). Additionally, an increase in the length of both the outer and inner curvatures of the AA was observed from 102.21 ± 10.17 mm to 105.73 ± 11.2 mm (+ 3.33% p = 0.016) and from 55.55 ± 9.53 mm to 58.35 ± 9.96 mm (+4.8%, p = 0.04), respectively. This study introduced a new repeatable and reproducible method for assessing the AoSA using cardiac-CTA images. Thoracic stent deployment changes the AoSA, potentially impacting long-term left ventricle hemodynamics.

Keywords: TEVAR; aorto-septal angle; cardiac remodelling; thoracic aorta.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as potential conflicts of interest.

Figures

Figure 1
Figure 1
Heart 3D model. On the left side, the complete model is shown, while on the right side, the cardiac model is depicted with three different views, along with the axes used for calculating the aorto-septal angle. The aortic axis is represented in red, and the ventricular axis is in green.
Figure 2
Figure 2
Diagram illustrating the analysis procedure: 3D models were obtained from medical images, which were then used to calculate the aortic centreline and define the aortic axis (in red) and the ventricular axis (in yellow) for the computation of the AoSA (in blue).
Figure 3
Figure 3
The image shows how to calculate the length of the inner and outer lines of the ascending aorta. In the first image on the left, contour lines are used to represent areas of constant temperature. Next, the points that create the longest path (outer line) and the shortest path (inner line) are identified and connected in order to calculate their lengths.
Figure 4
Figure 4
Intra-observer variability measurement.
See this image and copyright information in PMC

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