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Quantitative Analysis of Aortic Valve Stenosis and Aortic Root Dimensions by Three-Dimensional Echocardiography in Patients Scheduled for Transcutaneous Aortic Valve Implantation.

Jánosi RA, Plicht B, Kahlert P, Eißmann M, Wendt D, Jakob H, Erbel R, Buck T - Curr Cardiovasc Imaging Rep (2014)

Bottom Line: RT3D-TEE methods for planimetry and the LVOT-derived continuity equation for the estimation of AVA showed a good correlation.As iatrogenic coronary ostium occlusion is a potentially life-threatening complication, we evaluated the distances from the aortic annulus to the coronary ostia using RT3D-TEE.Based on our findings, we conclude that the geometry of the aortic root and aortic valve can be reliably and feasibly evaluated using RT3D-TEE, which is important for protecting against potential complications of TAVI, such as underestimation of the size of the aortic annulus that can result in aortic regurgitation and dislocation of the valve, or overestimation can lead to annulus rupture.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, West-German Heart and Vascular Center, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany.

ABSTRACT

Accurate assessment of the aortic valve area (AVA) and evaluation of the aortic root are important for clinical decision-making in patients being considered for transcatheter aortic valve implantation (TAVI). Real-time three-dimensional transesophageal echocardiography (RT3D-TEE) provides accurate and reliable quantitative assessment of aortic valve stenosis and the aortic root. We performed two-dimensional transthoracic echocardiography (2D-TTE), real-time 2D transesophageal echocardiography (RT2D-TEE) and RT3D-TEE in 71 consecutive patients referred for TAVI. RT3D-TEE multiplanar reconstruction was used to measure aortic root parameters, including left ventricular outflow tract (LVOT) diameter and area, aortic annulus diameter, aortic annulus area, and AVA. RT3D-TEE methods for planimetry and the LVOT-derived continuity equation for the estimation of AVA showed a good correlation. As iatrogenic coronary ostium occlusion is a potentially life-threatening complication, we evaluated the distances from the aortic annulus to the coronary ostia using RT3D-TEE. Based on our findings, we conclude that the geometry of the aortic root and aortic valve can be reliably and feasibly evaluated using RT3D-TEE, which is important for protecting against potential complications of TAVI, such as underestimation of the size of the aortic annulus that can result in aortic regurgitation and dislocation of the valve, or overestimation can lead to annulus rupture.

No MeSH data available.


Related in: MedlinePlus

Measurement of the aortic root by RT3D-TEE. From a live 3D zoom dataset, two orthogonal long-axis views of the aortic valve were positioned in the multiplanar reconstruction mode (a sagittal, b coronal). Using a third plane, the cross-sectional view of the aortic valve for correct tracing of the aortic valve area was selected (c). The aortic valve area was traced at the moment of maximal systolic opening. Then the short-axis view was shifted to the level of the aortic annulus, where the annular area and maximum and minimal diameters were measured (d). Finally, by adjusting the imaging plane within the long-axis view, the distance between the aortic annulus and coronary ostia could be measured (e, f RCA; g, h LCA)
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Fig1: Measurement of the aortic root by RT3D-TEE. From a live 3D zoom dataset, two orthogonal long-axis views of the aortic valve were positioned in the multiplanar reconstruction mode (a sagittal, b coronal). Using a third plane, the cross-sectional view of the aortic valve for correct tracing of the aortic valve area was selected (c). The aortic valve area was traced at the moment of maximal systolic opening. Then the short-axis view was shifted to the level of the aortic annulus, where the annular area and maximum and minimal diameters were measured (d). Finally, by adjusting the imaging plane within the long-axis view, the distance between the aortic annulus and coronary ostia could be measured (e, f RCA; g, h LCA)

Mentions: The aortic root is the direct continuation of the LVOT, beginning from the insertion of the aortic valvular cusps to the level of the sinotubular junction [4]. Its anatomy and diameter vary in patients with AS or aortic regurgitation as well as in the healthy population [17]. The measurement of the aortic annulus is the key measurement for the preparation of patients undergoing TAVI. Undersizing may lead to prosthesis migration or paravalvular regurgitation [18]. Even oversizing may cause problems such as complications related to vascular access, due to the delivery system or insufficient expansion of the prosthesis, reducing the valve’s durability [4]. We have previously described a method for the rapid, detailed 3D measurement of the aortic annulus using the ability of 3D measurements to identify the accurate diameter [19]. The aortic annulus should typically be measured in systole between the insertion of the AV cusps, not including the calcification of the aortic cusps (Fig. 1) [19, 20••]. Particularly when the annulus diameter is in the borderline range, the use of RT3D-TEE with analysis of volumetric data is helpful.


Quantitative Analysis of Aortic Valve Stenosis and Aortic Root Dimensions by Three-Dimensional Echocardiography in Patients Scheduled for Transcutaneous Aortic Valve Implantation.

Jánosi RA, Plicht B, Kahlert P, Eißmann M, Wendt D, Jakob H, Erbel R, Buck T - Curr Cardiovasc Imaging Rep (2014)

Measurement of the aortic root by RT3D-TEE. From a live 3D zoom dataset, two orthogonal long-axis views of the aortic valve were positioned in the multiplanar reconstruction mode (a sagittal, b coronal). Using a third plane, the cross-sectional view of the aortic valve for correct tracing of the aortic valve area was selected (c). The aortic valve area was traced at the moment of maximal systolic opening. Then the short-axis view was shifted to the level of the aortic annulus, where the annular area and maximum and minimal diameters were measured (d). Finally, by adjusting the imaging plane within the long-axis view, the distance between the aortic annulus and coronary ostia could be measured (e, f RCA; g, h LCA)
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4260114&req=5

Fig1: Measurement of the aortic root by RT3D-TEE. From a live 3D zoom dataset, two orthogonal long-axis views of the aortic valve were positioned in the multiplanar reconstruction mode (a sagittal, b coronal). Using a third plane, the cross-sectional view of the aortic valve for correct tracing of the aortic valve area was selected (c). The aortic valve area was traced at the moment of maximal systolic opening. Then the short-axis view was shifted to the level of the aortic annulus, where the annular area and maximum and minimal diameters were measured (d). Finally, by adjusting the imaging plane within the long-axis view, the distance between the aortic annulus and coronary ostia could be measured (e, f RCA; g, h LCA)
Mentions: The aortic root is the direct continuation of the LVOT, beginning from the insertion of the aortic valvular cusps to the level of the sinotubular junction [4]. Its anatomy and diameter vary in patients with AS or aortic regurgitation as well as in the healthy population [17]. The measurement of the aortic annulus is the key measurement for the preparation of patients undergoing TAVI. Undersizing may lead to prosthesis migration or paravalvular regurgitation [18]. Even oversizing may cause problems such as complications related to vascular access, due to the delivery system or insufficient expansion of the prosthesis, reducing the valve’s durability [4]. We have previously described a method for the rapid, detailed 3D measurement of the aortic annulus using the ability of 3D measurements to identify the accurate diameter [19]. The aortic annulus should typically be measured in systole between the insertion of the AV cusps, not including the calcification of the aortic cusps (Fig. 1) [19, 20••]. Particularly when the annulus diameter is in the borderline range, the use of RT3D-TEE with analysis of volumetric data is helpful.

Bottom Line: RT3D-TEE methods for planimetry and the LVOT-derived continuity equation for the estimation of AVA showed a good correlation.As iatrogenic coronary ostium occlusion is a potentially life-threatening complication, we evaluated the distances from the aortic annulus to the coronary ostia using RT3D-TEE.Based on our findings, we conclude that the geometry of the aortic root and aortic valve can be reliably and feasibly evaluated using RT3D-TEE, which is important for protecting against potential complications of TAVI, such as underestimation of the size of the aortic annulus that can result in aortic regurgitation and dislocation of the valve, or overestimation can lead to annulus rupture.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, West-German Heart and Vascular Center, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany.

ABSTRACT

Accurate assessment of the aortic valve area (AVA) and evaluation of the aortic root are important for clinical decision-making in patients being considered for transcatheter aortic valve implantation (TAVI). Real-time three-dimensional transesophageal echocardiography (RT3D-TEE) provides accurate and reliable quantitative assessment of aortic valve stenosis and the aortic root. We performed two-dimensional transthoracic echocardiography (2D-TTE), real-time 2D transesophageal echocardiography (RT2D-TEE) and RT3D-TEE in 71 consecutive patients referred for TAVI. RT3D-TEE multiplanar reconstruction was used to measure aortic root parameters, including left ventricular outflow tract (LVOT) diameter and area, aortic annulus diameter, aortic annulus area, and AVA. RT3D-TEE methods for planimetry and the LVOT-derived continuity equation for the estimation of AVA showed a good correlation. As iatrogenic coronary ostium occlusion is a potentially life-threatening complication, we evaluated the distances from the aortic annulus to the coronary ostia using RT3D-TEE. Based on our findings, we conclude that the geometry of the aortic root and aortic valve can be reliably and feasibly evaluated using RT3D-TEE, which is important for protecting against potential complications of TAVI, such as underestimation of the size of the aortic annulus that can result in aortic regurgitation and dislocation of the valve, or overestimation can lead to annulus rupture.

No MeSH data available.


Related in: MedlinePlus