title: Three-dimensional echocardiography in paravalvular aortic regurgitation assessment after transcatheter aortic valve implantation.
abstract: BACKGROUND
  Paravalvular aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) is common, but the evaluation of its severity by two-dimensional (2D) transthoracic echocardiography (TTE) presents several constrains. The aim of this study was to assess the usefulness of a new methodology, using three-dimensional (3D) TTE, for better assessment of paravalvular AR after TAVI.
  
  
  METHODS
  Two-dimensional and 3D TTE was performed in 72 patients, 5 months after TAVI, using the X5-1 PureWave microbeamforming xMATRIX probe. The position and severity of the paravalvular AR jets were described using 2D and 3D TTE, and a model was designed for paravalvular AR systematic location description. Vena contracta width was measured using 2D transthoracic echocardiographic views, and the planimetry of the vena contracta was assessed after the perfect alignment plane was obtained using the multiplanar 3D transthoracic echocardiographic reconstruction tool. AR volume was calculated as the difference between 3D TTE-derived total left ventricular stroke volume and right ventricular stroke volume estimated using 2D TTE. Diagnostic efficiency for moderate AR was assessed using receiver operating characteristic curve analysis.
  
  
  RESULTS
  Forty-three patients (57.4%) presented with AR; 10 (13.3%) had central AR, and 33 (44.0%) had paravalvular AR jets. Vena contracta widths were similar between patients with moderate and mild AR (2.1 ± 0.53 vs 1.9 ± 0.16 mm, P = .16), but vena contracta planimetry was larger in patients with moderate AR than in those with mild AR (0.30 ± 0.12 vs 0.09 ± 0.07 cm(2), P = .001). Vena contracta planimetry on 3D TTE was better correlated with AR volume than vena contracta width on 2D TTE (Kendall's τ = 0.82 [P < .001] vs 0.66 [P < .001]). The areas under the receiver operating characteristic curves were 0.96 for vena contracta planimetry and 0.35 for vena contracta width.
  
  
  CONCLUSIONS
  This study proposes an alternative methodology for paravalvular AR assessment after TAVI. Using vena contracta planimetry on 3D TTE, an accurate methodology for paravalvular AR jet evaluation and moderate AR classification is described.
authors.affiliation: Cardiovascular Institute, Hospital Clínico San Carlos, Complutense University, Madrid, Spain.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Gonçalves
authors.forename: Carlos
authors.initials: C
authors.lastname: Almeria
authors.forename: Pedro
authors.initials: P
authors.lastname: Marcos-Alberca
authors.forename: Gisela
authors.initials: G
authors.lastname: Feltes
authors.forename: Rosana
authors.initials: R
authors.lastname: Hernández-Antolín
authors.forename: Enrique
authors.initials: E
authors.lastname: Rodríguez
authors.forename: José C Silva
authors.initials: JC
authors.lastname: Cardoso
authors.forename: Carlos
authors.initials: C
authors.lastname: Macaya
authors.forename: José Luis
authors.initials: JL
authors.lastname: Zamorano
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging* / Q000209:etiology*; D006328:Cardiac Catheterization / Q000009:adverse effects*; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome