Quantitative Analysis of Aortic Valve Stenosis and Aortic Root Dimensions by Three-Dimensional Echocardiography in Patients Scheduled for Transcutaneous Aortic Valve Implantation

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.

Grading of aortic stenosis severity: a head-to-head comparison between cardiac magnetic resonance imaging and echocardiography

“…Thanks to this method, we show that the LVOT cross-section is typically elliptical and not circular; as a consequence, TTE underestimates the LVOT area calculated assuming a circular geometry. This is in agreement with conclusions derived from 3-D echocardiography 28 and from another comparison of TTE and CMR 29 .…”

The relation of left ventricular geometry to left ventricular outflow tract shape and stroke volume index calculations

“…We read with interest the article entitled as " The relation of left ventricular geometry to left ventricular outflow tract shape and stroke volume index calculations" that was published in LVOT geometry is an important factor for selecting a bioprosthetic valve during transcatheter aortic valve implantations (TAVI). 3,4 Unfortunately, most TAVI patients have sigmoid septum. 5 Hence, we need a study that clarifies the relationship between RWT-ASE and LVOT geometry in patients with nonconcentric hypertrophy.…”

“…In addition,LVOT geometry is an important factor for selecting a bioprosthetic valve during transcatheter aortic valve implantations (TAVI). 3,4 Unfortunately, most TAVI patients have sigmoid septum. 5 Hence, we need a study that clarifies the relationship between RWT-ASE and LVOT geometry in patients with nonconcentric hypertrophy.The inclusion of an additional group such as patients with nonconcentric hypertrophy will be more helpful for further clarification or another formula may be used instead of RWT for truly determining LVOT geometry.…”

“…LVOT geometry is an important factor for selecting a bioprosthetic valve during transcatheter aortic valve implantations (TAVI). 3,4 Unfortunately, most TAVI patients have sigmoid septum. 5 Hence, we need a study that clarifies the relationship between RWT-ASE and LVOT geometry in patients with nonconcentric hypertrophy.…”

Ecocardiografía avanzada: aplicación clínica actual del análisis de deformación miocárdica y de la imagen tridimensional

“…El ETT/ETE 3D proporcionan una visión más real. De lo anterior se deduce que el cálculo del área valvular aórtica, derivada de estos valores, es más exacto, mejorando así la evaluación de la severidad de la valvulopatía (Jánosi et al 2014). …”