title: Impact of valvular calcification on the diagnostic accuracy of transesophageal echocardiography for the detection of congenital aortic valve malformation.
abstract: BACKGROUND
  Degeneration of congenital bicuspid or unicuspid aortic valves can progress more rapidly than that of tricuspid valves, and an early diagnosis significantly impacts decision making and outcome. We hypothesized that the extent of valvular calcification would negatively influence the diagnostic accuracy of multiplane transesophageal echocardiography (TEE) for the diagnosis of congenital aortic valve disease.
  
  
  METHODS
  TEE was performed in 57 patients undergoing aortic valve replacement surgery for aortic stenosis (n = 46), pure regurgitation (n = 9), or significant regurgitation with less than severe aortic stenosis (n = 2). The degree of aortic valve calcification and the number of valve cusps were determined at surgery.
  
  
  RESULTS
  Surgical inspection confirmed 14 bicuspid and 43 tricuspid aortic valves. Sensitivity and specificity of TEE for the diagnosis of congenital aortic valve malformation was 93% (13/14) and 91% (39/43) (P = 0.0001), respectively. In patients with no or mild aortic valve calcification (n = 13), sensitivity and specificity of TEE for the diagnosis of congenitally malformed aortic valve was 100% (5/5) and 100% (8/8) (P = 0.001), respectively. In patients with moderate or marked aortic valve calcification (n = 44), sensitivity and specificity of TEE for the diagnosis of congenitally malformed aortic valve was 89% (8/9) and 89% (31/35) (P<0.0001), respectively. In this subgroup of 44 patients, there were four false-positive and one false-negative diagnoses due to valvular calcification.
  
  
  CONCLUSIONS
  Although TEE is highly sensitive and specific for the detection of congenital aortic valve malformations, presence of moderate or marked calcification of the aortic valve may result in false positive and false negative diagnoses.
authors.affiliation: Division of Cardiology, Department of Medicine, University of Louisville, Louisville, KY 40292, USA.
authors.forename: Akash
authors.initials: A
authors.lastname: Makkar
authors.forename: Tariq S
authors.initials: TS
authors.lastname: Siddiqui
authors.forename: Marcus F
authors.initials: MF
authors.lastname: Stoddard
authors.forename: Robert K
authors.initials: RK
authors.lastname: Lewis
authors.forename: Buddhadeb
authors.initials: B
authors.lastname: Dawn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging*; D016477:Artifacts; D002114:Calcinosis / Q000000981:diagnostic imaging*; D009202:Cardiomyopathies / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging*; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity