Three-Dimensional Imaging of the Left Ventricular Outflow Tract: Impact on Aortic Valve Area Estimation by the Continuity Equation

Gaspar, Tamar; Adawi, Salim; Sachner, Robert; Asmer, Ihab; Ganaeem, Majdi; Rubinshtein, Ronen; Shiran, Avinoam

doi:10.1016/j.echo.2012.05.001

Cited by 106 publications

(89 citation statements)

References 30 publications

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“…5 These inconsistencies have been attributed to stroke volume variability, despite normally appearing left ventricular (LV) function, small LV size, diastolic dysfunction, chronic afterload changes from hypertension, and underestimation of AVA secondary to the erroneous assumption that the left ventricular outflow tract (LVOT) is a circle rather than an ellipse. [6][7][8][9][10][11][12] Inconsistent AS grading is problematic because misinterpretation of grading parameters may delay surgical intervention and negatively affect patients. [1][2][3] AS severity is defined by the following echocardiographic parameters: peak velocity, ΔP m , AVA by continuity equation, dimensionless index, and indexed AVA (Table 1).…”

mentioning

confidence: 99%

Discordance in Grading Methods of Aortic Stenosis by Pre-Cardiopulmonary Bypass Transesophageal Echocardiography

Whitener

McKenzie

Akushevich

et al. 2016

Anesthesia &Amp; Analgesia

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Discordance in Grading Aortic Stenosis by Pre-CPB TEE aortic valve. For this reason, AVA calculation is prone to error compared with a ΔP m measurement.Although inconsistencies for grading AS with AVA and ΔP m are well known for preoperative TTE, they are routinely used for grading AS in the pre-cardiopulmonary bypass (pre-CPB) context. In this study, we investigate the frequency of discordance between grading AS with ΔP m measurements and AVA calculations during pre-CPB transesophageal echocardiography (TEE) to provide insight into their reliability for pre-CPB assessment of AS severity. Conventional AS severity cutoffs were derived from TTE studies performed in awake, spontaneously breathing patients.14-18 However, cardiac anesthesiologists perform pre-CPB TEE in anesthetized patients receiving positive pressure ventilation. Because general anesthesia and positive pressure ventilation may influence cardiac loading conditions, we hypothesized that grading discordance by pre-CPB TEE would be higher than previously reported for TTE by others. METHODSWe obtained Duke University IRB approval, which granted waiver of consent to perform a retrospective database study for information collected between January 1, 2000, and December 31, 2012. This study was an investigator-initiated, single-center, retrospective review of the Duke University, Department of Anesthesiology perioperative echocardiography-reporting database. This database includes all adult patients who have undergone cardiac surgery at Duke University Medical Center and had a TEE report generated electronically since January 1, 2000. The Duke Health Information Technologies Solutions (DHTS) Perioperative Development Group (PDG) maintains the reporting system. A cardiothoracic anesthesiology fellow, attending, or both, generated TEE reports as part of a dedicated perioperative echocardiography training program. All imaging and reports were subsequently reviewed offline by an independent cardiothoracic anesthesiologist to confirm the accuracy of the report. Subject SelectionWe reviewed all patients in the database, who underwent AVR with or without coronary artery bypass grafting from January 1, 2000, until December 31, 2012. Patients were included if the echocardiographer reported both a pre-CPB ΔP m and an AVA. Patients were excluded if they had emergency surgery or repeat sternotomy. Patients were also excluded if they had an ejection fraction <55%, moderate or severe mitral regurgitation (MR), or severe aortic insufficiency (AI). Definitions of Variables Statistical AnalysisIRB approval was obtained in early 2013; therefore, we collected retrospective data as far as possible, up through December 31, 2012. Pre-CPB TEE ΔP m and AVA values were extracted for all patients meeting clinical inclusion criteria. These values were grouped according to AS severity (mild, moderate, and severe) and compared for discordance rates based on current grading guidelines for ΔP m and AVA. Values were considered "discordant" if there was disagreement between severities bas...

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confidence: 99%

Discordance in Grading Methods of Aortic Stenosis by Pre-Cardiopulmonary Bypass Transesophageal Echocardiography

Whitener

McKenzie

Akushevich

et al. 2016

Anesthesia &Amp; Analgesia

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“…Výsledkem je podhodnocení plochy LVOT až o 17 %. 101 To představuje problém, protože hodnota průměru LVOT se v rovnici kontinuity umocňuje na druhou a chyba měření se tak zvětšuje. Tuto chybu lze odstranit použitím bezrozměrného indexu, což je poměr mezi VTI LVOT a VTI AV při vyloučení hodnoty průměru LVOT v rovnici, výsledkem je menší chyba.…”

Section: Další Zdroje Chyb/nejednotnostiunclassified

“…This leads to the underestimation of the LVOT area by up to 17%. 101 This is problematic because the LVOT diameter measurement is squared in the continuity equation, thus amplifying the measurement error. This can be overcome by using the dimensionless index that is the ratio between the LVOT VTI and AV VTI, ignoring the LVOT diameter in the equation, and is thus less subject to error measurement.…”

Section: Other Sources Of Errors/inconsistenciesmentioning

confidence: 99%

Accurate Assessment of Aortic Stenosis

et al. 2014

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“…However, because of poor 3D TTE image quality, the study only found moderate correlation between CCTA and 3D TTE LVOT area because of poor 3D TTE image quality (7). TEE has better imaging windows which to generate higher quality 2D and therefore 3D images and may overcome this problem (7). In high quality 3D TEE acquisitions, the LVOT area can be approximated by lining up two orthogonal long-axis planes and tracing the cross-sectional plane in short axis using quantification software ( Figure 2).…”

Section: Left Ventricular Volume and Functionmentioning

confidence: 84%

“…Therefore, there is an inherent error built into the stroke volume equation, with the 2D LVOT area usually underestimating the real LVOT area. However, because of poor 3D TTE image quality, the study only found moderate correlation between CCTA and 3D TTE LVOT area because of poor 3D TTE image quality (7). TEE has better imaging windows which to generate higher quality 2D and therefore 3D images and may overcome this problem (7).…”

Section: Left Ventricular Volume and Functionmentioning

confidence: 99%

An update on intraoperative three-dimensional transesophageal echocardiography

Rong¹

2017

J. Thorac. Dis.

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Three-Dimensional Imaging of the Left Ventricular Outflow Tract: Impact on Aortic Valve Area Estimation by the Continuity Equation

Cited by 106 publications

References 30 publications

Discordance in Grading Methods of Aortic Stenosis by Pre-Cardiopulmonary Bypass Transesophageal Echocardiography

Discordance in Grading Methods of Aortic Stenosis by Pre-Cardiopulmonary Bypass Transesophageal Echocardiography

Accurate Assessment of Aortic Stenosis

An update on intraoperative three-dimensional transesophageal echocardiography

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