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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

a Three-dimensional model of the aortic root showing the location of the various annular rings and junctions. b The close relationship between these structures and the coronary ostia can be seen (reprinted with kind permission from Piazza et al. [4])
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Fig2: a Three-dimensional model of the aortic root showing the location of the various annular rings and junctions. b The close relationship between these structures and the coronary ostia can be seen (reprinted with kind permission from Piazza et al. [4])

Mentions: Piazza et al. [4] defined four parts of the aortic root: a virtual annulus formed by the joining basal attachments of the AV leaflets, the anatomic annulus formed by the ventriculoarterial junction, the sinotubular junction, and a crown-like ring formed by the insertion of the leaflets. Thus the structure of the aortic annulus as measured by echocardiographic means is the virtual ring or the hinge point of the AV cusps (Fig. 2).Fig. 1


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)

a Three-dimensional model of the aortic root showing the location of the various annular rings and junctions. b The close relationship between these structures and the coronary ostia can be seen (reprinted with kind permission from Piazza et al. [4])
© Copyright Policy
Related In: Results  -  Collection

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

Fig2: a Three-dimensional model of the aortic root showing the location of the various annular rings and junctions. b The close relationship between these structures and the coronary ostia can be seen (reprinted with kind permission from Piazza et al. [4])
Mentions: Piazza et al. [4] defined four parts of the aortic root: a virtual annulus formed by the joining basal attachments of the AV leaflets, the anatomic annulus formed by the ventriculoarterial junction, the sinotubular junction, and a crown-like ring formed by the insertion of the leaflets. Thus the structure of the aortic annulus as measured by echocardiographic means is the virtual ring or the hinge point of the AV cusps (Fig. 2).Fig. 1

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