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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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Scatterplot of the implanted valve versus the virtual valve according to the degree of the AR
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Fig8: Scatterplot of the implanted valve versus the virtual valve according to the degree of the AR

Mentions: For patients who turned out to have no AR, the two methods agreed in 84.6 % of patients; for patients who turned out to have AR grade 1, the two methods agreed in 73.7 % of patients; for patients who turned out to have AR grade 2, the two methods agreed in 60.0 % of patients. So it could be argued that the TEE derived area method disagreed with the CT method more often when the sizing using CT turned out to be unsatisfactory (Fig. 8).Fig. 8


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)

Scatterplot of the implanted valve versus the virtual valve according to the degree of the AR
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig8: Scatterplot of the implanted valve versus the virtual valve according to the degree of the AR
Mentions: For patients who turned out to have no AR, the two methods agreed in 84.6 % of patients; for patients who turned out to have AR grade 1, the two methods agreed in 73.7 % of patients; for patients who turned out to have AR grade 2, the two methods agreed in 60.0 % of patients. So it could be argued that the TEE derived area method disagreed with the CT method more often when the sizing using CT turned out to be unsatisfactory (Fig. 8).Fig. 8

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