title: Measurement of aortic valve anatomic regurgitant area using transesophageal echocardiography: implications for the quantitation of aortic regurgitation.
abstract: BACKGROUND
  Various echocardiographic methods for the assessment of the severity of the aortic regurgitation (AR) by have been described with no general consensus.
  
  
  OBJECTIVE
  To assess the feasibility and reproducibility of direct planimetric measurement of the end-diastolic gap between aortic cusps on the transesophageal echocardiography (TEE) images in patients with AR. We also analyzed the correlation of this anatomic aortic regurgitanty area with angiographic AR severity.
  
  
  METHODS
  Ninety patients (38 males, 52 females, mean age 41 +/- 24 years) with AR who underwent TEE and contrast aortography in a single institution. The AR was graded angiographically as mild (n = 45), moderate (n = 31), and severe (n = 14). The anatomic regurgitant area was measured on the end-diastolic short-axis TEE images of the aortic valve by planimetering the central gap bordered by the commisural edges of the aortic cusps.
  
  
  RESULTS
  The intraobserver and interobserver variability for the measurement of aortic anatomic regurgitant area were small (mean absolute differences 0.01 +/- 0.01 cm(2), and 0.015 +/- 0.013 cm(2), respectively). The average values of anatomic regurgitant area for angiographically mild, moderate, and severe AR were 0.15 +/- 0.05 cm(2), 0.30 +/- 0.08 cm(2), and 0.68 +/- 0.33 cm(2), respectively (P <.001). When the anatomic regurgitant area was graded as small (> 0.2 cm(2)), moderate (> 0.2 and > 0.4 cm(2)) and large (> 0.4 cm(2)), the sensitivity, specificity, positive and negative predictive value, and the diagnostic accuracy for predicting the angiographically mild AR were 85%, 97%, 97%, 87%, and 91%, respectively. For the moderate angiographic AR the same values were 84%, 92%, 81%, 93%, and 90%, and for the severe angiographic AR they were 98%, 93%, 93%, 98% and 97%.
  
  
  CONCLUSIONS
  The planimetric measurement of aortic anatomic regurgitant area by TEE is feasible and reproducible for the assessment of the severity of AR.
authors.affiliation: Kosuyolu Heart and Research Hospital, Istanbul, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ozkan
authors.forename: Nihal
authors.initials: N
authors.lastname: Ozdemir
authors.forename: Cihangir
authors.initials: C
authors.lastname: Kaymaz
authors.forename: Cevat
authors.initials: C
authors.lastname: Kirma
authors.forename: Ubeydullah
authors.initials: U
authors.lastname: Deligönül
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000473:pathology*; D001022:Aortic Valve Insufficiency / Q000175:diagnosis* / Q000453:epidemiology; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D011859:Radiography; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index