Comparison of aortic root dimensions and geometries before and after transcatheter aortic valve implantation by 2- and 3-dimensional transesophageal echocardiography and multislice computed tomography.
BACKGROUND
3D transesophageal echocardiography (TEE) may provide more accurate aortic annular and left ventricular outflow tract (LVOT) dimensions and geometries compared with 2D TEE. We assessed agreements between 2D and 3D TEE measurements with multislice computed tomography (MSCT) and changes in annular/LVOT areas and geometries after transcatheter aortic valve implantations (TAVI).


RESULTS
Two-dimensional circular (pixr(2)), 3D circular, and 3D planimetered annular and LVOT areas by TEE were compared with "gold standard" MSCT planimetered areas before TAVI. Mean MSCT planimetered annular area was 4.65+/-0.82 cm(2) before TAVI. Annular areas were underestimated by 2D TEE circular (3.89+/-0.74 cm(2), P<0.001), 3D TEE circular (4.06+/-0.79 cm(2), P<0.001), and 3D TEE planimetered annular areas (4.22+/-0.77 cm(2), P<0.001). Mean MSCT planimetered LVOT area was 4.61+/-1.20 cm(2) before TAVI. LVOT areas were underestimated by 2D TEE circular (3.41+/-0.89 cm(2), P<0.001), 3D TEE circular (3.89+/-0.94 cm(2), P<0.001), and 3D TEE planimetered LVOT areas (4.31+/-1.15 cm(2), P<0.001). Three-dimensional TEE planimetered annular and LVOT areas had the best agreement with respective MSCT planimetered areas. After TAVI, MSCT planimetered (4.65+/-0.82 versus 4.20+/-0.46 cm(2), P<0.001) and 3D TEE planimetered (4.22+/-0.77 versus 3.62+/-0.43 cm(2), P<0.001) annular areas decreased, whereas MSCT planimetered (4.61+/-1.20 versus 4.84+/-1.17 cm(2), P=0.002) and 3D TEE planimetered (4.31+/-1.15 versus 4.55+/-1.21 cm(2), P<0.001) LVOT areas increased. Aortic annulus and LVOT became less elliptical after TAVI.


CONCLUSIONS
Before TAVI, 2D and 3D TEE aortic annular/LVOT circular geometric assumption underestimated the respective MSCT planimetered areas. After TAVI, 3D TEE and MSCT planimetered annular areas decreased as it assumes the internal dimensions of the prosthetic valve. However, planimetered LVOT areas increased due to a more circular geometry.
Ng
Arnold C T
AC
Department of Cardiology, the Department of Cardiothoracic Surgery, and the Department of Radiology, Leiden University Medical Center, Albinusdreef 2, Leiden, The Netherlands.
Delgado
Victoria
V
van der Kley
Frank
F
Shanks
Miriam
M
van de Veire
Nico R L
NR
Bertini
Matteo
M
Nucifora
Gaetano
G
van Bommel
Rutger J
RJ
Tops
Laurens F
LF
de Weger
Arend
A
Tavilla
Giuseppe
G
de Roos
Albert
A
Kroft
Lucia J
LJ
Leung
Dominic Y
DY
Schuijf
Joanne
J
Schalij
Martin J
MJ
Bax
Jeroen J
JJ
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging*; D001024:Aortic Valve Stenosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy*; D006328:Cardiac Catheterization; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D015588:Observer Variation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011474:Prosthesis Design; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome