title: Multimodal assessment of the aortic annulus diameter: implications for transcatheter aortic valve implantation.
abstract: 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.
authors.affiliation: INSERM, U698, University Paris 7, Paris, France. david.messika-zeitoun@bch.aphp.fr
authors.forename: David
authors.initials: D
authors.lastname: Messika-Zeitoun
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Serfaty
authors.forename: Eric
authors.initials: E
authors.lastname: Brochet
authors.forename: Gregory
authors.initials: G
authors.lastname: Ducrocq
authors.forename: Laurent
authors.initials: L
authors.lastname: Lepage
authors.forename: Delphine
authors.initials: D
authors.lastname: Detaint
authors.forename: Fabien
authors.initials: F
authors.lastname: Hyafil
authors.forename: Dominique
authors.initials: D
authors.lastname: Himbert
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Pasi
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Laissy
authors.forename: Bernard
authors.initials: B
authors.lastname: Iung
authors.forename: Alec
authors.initials: A
authors.lastname: Vahanian
mesh_terms: 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