Multimodal assessment of the aortic annulus diameter: implications for transcatheter aortic valve implantation.
OBJECTIVE
We sought to compare 3 methods of measurements of the aortic annulus, transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and multislice computed tomography (MSCT), and to evaluate their potential clinical impact on transcatheter aortic valve implantation (TAVI) strategy.


BACKGROUND
Exact measurement of the aortic annulus is critical for a patient's selection and successful implantation.


METHODS
Annulus diameter was measured using TTE, TEE, and MSCT in 45 consecutive patients with severe aortic stenosis referred for TAVI. The TAVI strategy (decision to implant and choice of the prosthesis' size) was based on manufacturer's recommendations (Edwards-Sapien prosthesis, Edwards Lifesciences, Inc., Irvine, California).


RESULTS
Correlations between methods were good but the difference between MSCT and TTE (1.22 +/- 1.3 mm) or TEE (1.52 +/- 1.1 mm) was larger than the difference between TTE and TEE (0.6 +/- 0.8 mm; p = 0.03 and p < 0.0001, respectively). Regarding TAVI strategy, agreement between TTE and TEE overall was good (kappa = 0.68), but TAVI strategy would have been different in 8 patients (17%). Agreement between MSCT and TTE or TEE was only modest (kappa = 0.28 and 0.27), and a decision based on MSCT measurements would have modified the TAVI strategy in a large number of patients (40% to 42%). Implantation, performed in 34 patients (76%) based on TEE measurements, was successful in all but 1 patient with grade 3/4 regurgitation.


CONCLUSIONS
In patients referred for TAVI, measurements of the aortic annulus using TTE, TEE, and MSCT were close but not identical, and the method used has important potential clinical implications on TAVI strategy. In the absence of a gold standard, a strategy based on TEE measurements provided good clinical results.
Messika-Zeitoun
David
D
INSERM, U698, University Paris 7, Paris, France. david.messika-zeitoun@bch.aphp.fr
Serfaty
Jean-Michel
JM
Brochet
Eric
E
Ducrocq
Gregory
G
Lepage
Laurent
L
Detaint
Delphine
D
Hyafil
Fabien
F
Himbert
Dominique
D
Pasi
Nicoletta
N
Laissy
Jean-Pierre
JP
Iung
Bernard
B
Vahanian
Alec
A
D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000000981:diagnostic imaging / Q000473:pathology*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery; D006328:Cardiac Catheterization; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D015588:Observer Variation; D018579:Patient Selection; D011474:Prosthesis Design; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed