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Two-dimensional transesophageal echocardiography for aortic annular sizing in patients undergoing transcatheter aortic valve implantation.

Sherif MA, Ince H, Maniuc O, Reiter T, Voelker W, Ertl G, Öner A - BMC Cardiovasc Disord (2015)

Bottom Line: Accurate preoperative assessment of the aortic annulus dimension is crucial for successful transcatheter aortic valve implantation (TAVI).CT remanis the gold standard in sizing of the aortic valve annulus.Nevertheless, sizing of the aortic valve annulus using TEE derived area may be helpful.

View Article: PubMed Central - PubMed

Affiliation: Internal Medicine Centre, Cardiology Department, Rostock University Clinic, Ernst-Hyedemann- Street 6, 18057, Rostock, Germany. mohammad_sherif@hotmail.com.

ABSTRACT

Background: Accurate preoperative assessment of the aortic annulus dimension is crucial for successful transcatheter aortic valve implantation (TAVI). In this study we examined the accuracy of a novel method using two-dimensional transesophageal echocardiography (2D-TEE) for measurement of the aortic annulus.

Methods: We evaluated the theoretical impact of the measurement of the annulus diameter and area using the circumcircle of a triangle method on the decision to perform the procedure and choice of the prosthesis size.

Results: Sixty-three consecutive patients were scheduled for TAVI. Mean age was 82 ± 4 years, and 25 patients (55.6 %) were female. Mean aortic annulus diameter was 20.3 ± 2.2 mm assessed by TEE on the mid-esophageal long-axis view and 23.9 ± 2.3 mm using CT (p < 0.001). There was a tendency for the TEE derived areas using the new method to be higher (p < 0.001). The TEE measurements were on average 42.33 mm(2) higher than the CT measurements without an evidence of a systematic over- or under-sizing (p = 1.00). Agreement between TEE and CT chosen valve sizes was good overall (kappa = 0.67 and weighted kappa = 0.71). For patients who turned out to have no AR, the two methods agreed in 84.6 % of patients.

Conclusions: CT remanis the gold standard in sizing of the aortic valve annulus. Nevertheless, sizing of the aortic valve annulus using TEE derived area may be helpful. The impact of integration of this method in the algorithm of aortic annulus sizing on the outcome of patients undergoing TAVI should be examined in future studies.

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Related in: MedlinePlus

Annular size measurement using the enlarged view of the mid-oesophageal short axis (approximately 30° to 50°). The short-axis views of the aortic valve are generated at the insertion of the cusps in early systole. Red circles identify the thickened parts at the sites of peripheral attachment of the zones of apposition between the aortic valve leaflets. They represent also the vertices of the interleaflet triangles. LCC: left coronary cusp, RCC: right coronary cusp, NCC: non-coronary cusp
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Fig1: Annular size measurement using the enlarged view of the mid-oesophageal short axis (approximately 30° to 50°). The short-axis views of the aortic valve are generated at the insertion of the cusps in early systole. Red circles identify the thickened parts at the sites of peripheral attachment of the zones of apposition between the aortic valve leaflets. They represent also the vertices of the interleaflet triangles. LCC: left coronary cusp, RCC: right coronary cusp, NCC: non-coronary cusp

Mentions: Annular size measurement was performed using the enlarged view of the mid-esophageal short axis (approximately 30° to 50°) during the early systolic phase of the cardiac cycle. The short-axis views of the aortic valve were generated at the insertion of the cusps in systole. The mid-esophageal AV short axis view was obtained from the mid-esophageal window by advancing or withdrawing the probe until the AV comes into view and then turning the probe to center the AV in the display. The image depth was adjusted to between 10 to 12 cm to position the AV in the middle of the display. Next, the multiplane angle was rotated forward to approximately 30 to 60° until a symmetrical image of all three cusps of the aortic valve and the coronary sinuses comes into view. This view shows how the leaflets join together along trifoliate zones of apposition extending from peripheral attachments at the sinutubular junction to the centroid of the valvular orifice (Fig. 1). These zones of apposition are the true commissures. The aortal end of the commissures correlates anatomically to the upper end of the inter-leaflet triangle and at the same time they represent the sinutubular junction (blue ring in Fig. 2). Three points were defined (red circles Fig. 1). Three lines were drawn between these points and the resulting triangle was used to identify the circle that intersects the three vertices of the triangle i.e. circumcircle of the triangle (yellow circle in Fig. 3).Fig. 1


Two-dimensional transesophageal echocardiography for aortic annular sizing in patients undergoing transcatheter aortic valve implantation.

Sherif MA, Ince H, Maniuc O, Reiter T, Voelker W, Ertl G, Öner A - BMC Cardiovasc Disord (2015)

Annular size measurement using the enlarged view of the mid-oesophageal short axis (approximately 30° to 50°). The short-axis views of the aortic valve are generated at the insertion of the cusps in early systole. Red circles identify the thickened parts at the sites of peripheral attachment of the zones of apposition between the aortic valve leaflets. They represent also the vertices of the interleaflet triangles. LCC: left coronary cusp, RCC: right coronary cusp, NCC: non-coronary cusp
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4696347&req=5

Fig1: Annular size measurement using the enlarged view of the mid-oesophageal short axis (approximately 30° to 50°). The short-axis views of the aortic valve are generated at the insertion of the cusps in early systole. Red circles identify the thickened parts at the sites of peripheral attachment of the zones of apposition between the aortic valve leaflets. They represent also the vertices of the interleaflet triangles. LCC: left coronary cusp, RCC: right coronary cusp, NCC: non-coronary cusp
Mentions: Annular size measurement was performed using the enlarged view of the mid-esophageal short axis (approximately 30° to 50°) during the early systolic phase of the cardiac cycle. The short-axis views of the aortic valve were generated at the insertion of the cusps in systole. The mid-esophageal AV short axis view was obtained from the mid-esophageal window by advancing or withdrawing the probe until the AV comes into view and then turning the probe to center the AV in the display. The image depth was adjusted to between 10 to 12 cm to position the AV in the middle of the display. Next, the multiplane angle was rotated forward to approximately 30 to 60° until a symmetrical image of all three cusps of the aortic valve and the coronary sinuses comes into view. This view shows how the leaflets join together along trifoliate zones of apposition extending from peripheral attachments at the sinutubular junction to the centroid of the valvular orifice (Fig. 1). These zones of apposition are the true commissures. The aortal end of the commissures correlates anatomically to the upper end of the inter-leaflet triangle and at the same time they represent the sinutubular junction (blue ring in Fig. 2). Three points were defined (red circles Fig. 1). Three lines were drawn between these points and the resulting triangle was used to identify the circle that intersects the three vertices of the triangle i.e. circumcircle of the triangle (yellow circle in Fig. 3).Fig. 1

Bottom Line: Accurate preoperative assessment of the aortic annulus dimension is crucial for successful transcatheter aortic valve implantation (TAVI).CT remanis the gold standard in sizing of the aortic valve annulus.Nevertheless, sizing of the aortic valve annulus using TEE derived area may be helpful.

View Article: PubMed Central - PubMed

Affiliation: Internal Medicine Centre, Cardiology Department, Rostock University Clinic, Ernst-Hyedemann- Street 6, 18057, Rostock, Germany. mohammad_sherif@hotmail.com.

ABSTRACT

Background: Accurate preoperative assessment of the aortic annulus dimension is crucial for successful transcatheter aortic valve implantation (TAVI). In this study we examined the accuracy of a novel method using two-dimensional transesophageal echocardiography (2D-TEE) for measurement of the aortic annulus.

Methods: We evaluated the theoretical impact of the measurement of the annulus diameter and area using the circumcircle of a triangle method on the decision to perform the procedure and choice of the prosthesis size.

Results: Sixty-three consecutive patients were scheduled for TAVI. Mean age was 82 ± 4 years, and 25 patients (55.6 %) were female. Mean aortic annulus diameter was 20.3 ± 2.2 mm assessed by TEE on the mid-esophageal long-axis view and 23.9 ± 2.3 mm using CT (p < 0.001). There was a tendency for the TEE derived areas using the new method to be higher (p < 0.001). The TEE measurements were on average 42.33 mm(2) higher than the CT measurements without an evidence of a systematic over- or under-sizing (p = 1.00). Agreement between TEE and CT chosen valve sizes was good overall (kappa = 0.67 and weighted kappa = 0.71). For patients who turned out to have no AR, the two methods agreed in 84.6 % of patients.

Conclusions: CT remanis the gold standard in sizing of the aortic valve annulus. Nevertheless, sizing of the aortic valve annulus using TEE derived area may be helpful. The impact of integration of this method in the algorithm of aortic annulus sizing on the outcome of patients undergoing TAVI should be examined in future studies.

Show MeSH
Related in: MedlinePlus