title: Prosthesis/annulus discongruence assessed by three-dimensional transoesophageal echocardiography: a predictor of significant paravalvular aortic regurgitation after transcatheter aortic valve implantation.
abstract: OBJECTIVE
  Paravalvular aortic regurgitation (AR) is common after transcatheter aortic valve implantation (TAVI). This study aimed to assess the prosthesis/aortic annulus discongruence by three-dimensional (3D) transoesophageal (TOE) planimetry of aortic annulus and its impact on the occurrence of significant AR after TAVI.
  
  
  RESULTS
  We included 33 patients who underwent TAVI with a balloon expandable device for severe aortic stenosis. To appraise the prosthesis/annulus discongruence, we defined a 'mismatch index' expressed as: annulus area - prosthesis area. The aortic annulus area was planimetered with 3D TOE, and approximated by circular area formula (π r(2)) using annulus diameter obtained by two-dimensional (2D) TOE. After TAVI, 13 patients (39.3%) developed significant AR (≥2/4). The occurrence of significant AR was associated to the 3D planimetered annulus area (P = 0.04), and the 'mismatch index' obtained through 3D planimetered annulus area (P = 0.03), but not to 'mismatch index' derived of 2D annulus diameter. In multivariate analysis, 'mismatch index' for 3D planimetered annulus area was the only independent predictor of significant AR (odds ratio: 10.614; 95% CI: 1.044-17.21; P = 0.04). The area under the receiver operating characteristic curve for the 'mismatch index' by the 3D planimetered annulus area was 0.76 (95% CI: 0.54-0.92), whereas for 'mismatch index' obtained by the 2D circular area was 0.36 (95% CI: 0.17-0.55). Using the 3D planimetered annulus area as the reference parameter to decide the prosthetic size, the choice would have been different in 21 patients (63%).
  
  
  CONCLUSIONS
  Three-dimensional TOE planimetry of aortic annulus improves the assessment of prosthesis/annulus discongruence and predicts the appearance of significant AR after TAVI.
authors.affiliation: Instituto Cardiovascular, Unidad de Imagen Cardiaca, Hospital Universitario San Carlos, Profesor Martin Lagos s/n, 28040 Madrid,  Spain.
authors.forename: Ninel
authors.initials: N
authors.lastname: Santos
authors.forename: José Alberto
authors.initials: JA
authors.lastname: de Agustín
authors.forename: Carlos
authors.initials: C
authors.lastname: Almería
authors.forename: Alejandra
authors.initials: A
authors.lastname: Gonçalves
authors.forename: Pedro
authors.initials: P
authors.lastname: Marcos-Alberca
authors.forename: Covadonga
authors.initials: C
authors.lastname: Fernández-Golfín
authors.forename: Eulogio
authors.initials: E
authors.lastname: García
authors.forename: Rosana
authors.initials: R
authors.lastname: Hernández-Antolín
authors.forename: Leopoldo Pérez
authors.initials: LP
authors.lastname: de Isla
authors.forename: Carlos
authors.initials: C
authors.lastname: Macaya
authors.forename: José
authors.initials: J
authors.lastname: Zamorano
mesh_terms: D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D016001:Confidence Intervals; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal / Q000379:methods*; D006305:Health Status Indicators; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D016017:Odds Ratio; D012372:ROC Curve; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013223:Statistics as Topic; D018709:Statistics, Nonparametric