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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

Overestimation of AVA by 2D-TEE. Before valve replacement is considered, the severity of stenosis must be accurately assessed. It is important to determine AVA using a flow-independent technique such as planimetry. In 2D methods, it is often difficult to capture the tip of the aortic valve leaflets at the moment of maximal systolic opening; this may lead to overestimation of AVA because of a “funnel” configuration. The example images show the imaging planes of a RT3D-TEE-acquired volumetric dataset with long-axis views (left) and en face views (right). Usual 2D planimetry at different levels could result in the different AVA dimensions of 1.15 cm2 and 0.75 cm2. This illustrates that optimal positioning of the imaging plane is essential for accurate planimetry of AVA
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Fig4: Overestimation of AVA by 2D-TEE. Before valve replacement is considered, the severity of stenosis must be accurately assessed. It is important to determine AVA using a flow-independent technique such as planimetry. In 2D methods, it is often difficult to capture the tip of the aortic valve leaflets at the moment of maximal systolic opening; this may lead to overestimation of AVA because of a “funnel” configuration. The example images show the imaging planes of a RT3D-TEE-acquired volumetric dataset with long-axis views (left) and en face views (right). Usual 2D planimetry at different levels could result in the different AVA dimensions of 1.15 cm2 and 0.75 cm2. This illustrates that optimal positioning of the imaging plane is essential for accurate planimetry of AVA

Mentions: The mean AVA calculated by 2D-TTE was 0.69 ± 0.28 cm2 with peak and mean pressure gradients across the AV of 67.3 ± 34.5 and 39.9 ± 21.5 mmHg, respectively (Table 1). A high correlation was noted between the planimetry of AVA by 2D-TEE and RT3D-TEE (r = 0.81, P < 0.1); however, 2D-TEE planimetry showed a significantly larger AVA than RT3D-TEE (0.71 ± 0.26 cm2 vs. 0.61 ± 0.23 cm2, P < 0.05); Fig. 2). Figure 3 shows different imaging planes for the same AV, demonstrating the reason for the overestimation of AV size. Further, considering the RT3D-derived LVOTAp in the CE yielded a higher calculated AVA (0.8 ± 0.58 cm2) (Fig. 4).Fig. 3


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)

Overestimation of AVA by 2D-TEE. Before valve replacement is considered, the severity of stenosis must be accurately assessed. It is important to determine AVA using a flow-independent technique such as planimetry. In 2D methods, it is often difficult to capture the tip of the aortic valve leaflets at the moment of maximal systolic opening; this may lead to overestimation of AVA because of a “funnel” configuration. The example images show the imaging planes of a RT3D-TEE-acquired volumetric dataset with long-axis views (left) and en face views (right). Usual 2D planimetry at different levels could result in the different AVA dimensions of 1.15 cm2 and 0.75 cm2. This illustrates that optimal positioning of the imaging plane is essential for accurate planimetry of AVA
© Copyright Policy
Related In: Results  -  Collection

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Fig4: Overestimation of AVA by 2D-TEE. Before valve replacement is considered, the severity of stenosis must be accurately assessed. It is important to determine AVA using a flow-independent technique such as planimetry. In 2D methods, it is often difficult to capture the tip of the aortic valve leaflets at the moment of maximal systolic opening; this may lead to overestimation of AVA because of a “funnel” configuration. The example images show the imaging planes of a RT3D-TEE-acquired volumetric dataset with long-axis views (left) and en face views (right). Usual 2D planimetry at different levels could result in the different AVA dimensions of 1.15 cm2 and 0.75 cm2. This illustrates that optimal positioning of the imaging plane is essential for accurate planimetry of AVA
Mentions: The mean AVA calculated by 2D-TTE was 0.69 ± 0.28 cm2 with peak and mean pressure gradients across the AV of 67.3 ± 34.5 and 39.9 ± 21.5 mmHg, respectively (Table 1). A high correlation was noted between the planimetry of AVA by 2D-TEE and RT3D-TEE (r = 0.81, P < 0.1); however, 2D-TEE planimetry showed a significantly larger AVA than RT3D-TEE (0.71 ± 0.26 cm2 vs. 0.61 ± 0.23 cm2, P < 0.05); Fig. 2). Figure 3 shows different imaging planes for the same AV, demonstrating the reason for the overestimation of AV size. Further, considering the RT3D-derived LVOTAp in the CE yielded a higher calculated AVA (0.8 ± 0.58 cm2) (Fig. 4).Fig. 3

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