Direct Planimetry of Left Ventricular Outflow Tract Area by Simultaneous Biplane Imaging: Challenging the Need for a Circular Assumption of the Left Ventricular Outflow Tract in the Assessment of Aortic Stenosis

Aortic valve area calculation using 3D transesophageal echocardiography: Implications for aortic stenosis severity grading

“…In a study by Gaspar et al, 3D‐TTE image quality resulted inadequate, and the reproducibility of LVOT area measurements by 3D‐TTE was inferior to that obtained by 2D‐TTE 11 . Conversely, in a recent study of 134 patients with AS, including 82 with severe AS, Liu et al demonstrated 90% feasibility and good reproducibility of 3D‐TTE simultaneous biplane LVOT area measurement using a modern echocardiographic system 12 . By applying 3D‐TTE to calculate AVA, discordant cases significantly reduced from 49% to 27%, and 29% of patients with severe AS identified by 2D‐TTE were reclassified to moderate AS 12 .…”

“…[7][8][9][10] 3D-TTE has been studied as an attractive readily available option to provide accurate LVOT measurement and AVA calculation without the need for alternative imaging modalities, however with limited feasibility and poor correlation with MDCT due to limited image quality. 11,12 The accuracy and reproducibility of 3D-TEE in AS grading have not been systematically assessed yet. The aims of this study were as follows: (a) to compare AVA measurement obtained using 3D-TEE manual (3D-TEE-m) and semi-automated software analysis (3D-TEE-s) to those obtained using MDCT as reference standard, (b) to evaluate the role of 3D-TEE imaging modalities compared to MDCT in AS grading, and (c) to assess whether the association between AVA and MPG is improved by the use of 3D-TEE imaging modalities.…”

“…In this setting, the use of a combined approach to assess AVA by merging 2D‐TTE‐derived Doppler parameters with MDCT 3D LVOT measurements has been proposed as an alternative method for AS grading 7‐10 . 3D‐TTE has been studied as an attractive readily available option to provide accurate LVOT measurement and AVA calculation without the need for alternative imaging modalities, however with limited feasibility and poor correlation with MDCT due to limited image quality 11,12 . The accuracy and reproducibility of 3D‐TEE in AS grading have not been systematically assessed yet.…”

“…Conversely, in a recent study of 134 patients with AS, including 82 with severe AS, Liu et al demonstrated 90% feasibility and good reproducibility of 3D-TTE simultaneous biplane LVOT area measurement using a modern echocardiographic system 12. By applying 3D-TTE to calculate AVA, discordant cases significantly reduced from 49% to 27%, and 29% of patients with severe AS identified by 2D-TTE were reclassified to moderate AS 12. However, correlation with MDCT was available only for 30 patients, hampering these results 12.…”

“…By applying 3D-TTE to calculate AVA, discordant cases significantly reduced from 49% to 27%, and 29% of patients with severe AS identified by 2D-TTE were reclassified to moderate AS 12. However, correlation with MDCT was available only for 30 patients, hampering these results 12. Further investigations are warranted to thoroughly assess the role of 3D-TTE in AS grading.The results of our study support the use of 3D-TEE combined AVA assessment in clinical practice as a valid and reliable alternative to MDCT to reconcile discordant 2D-TTE findings in AS grading.…”