title: Incremental utility of real time three-dimensional tranthoracic echocardiography in the assessment of congenitally malformed aortic valve.
abstract: OBJECTIVE
  To study the feasibility and additional value of real time three-dimensional transthoracic echocardiography (RT3D-TTE) for anatomical and functional assessment of malformed aortic valve (AV) compared to conventional two-dimensional TTE (2D-TTE).
  
  
  METHODS
  Malformed AV was evaluated in 35 patients (mean age 18 ± 9.5 years, 70% male) by both 2D-TTE and RT3D-TTE. The anatomical definition of aortic cusps (number, direction, and commissures) was evaluated by a 3-point visualization score (1: nonvisualized, 2: inadequate, 3: adequate). 2D-TTE and RT3D-TTE measurements included AV area and maximum diameters of both AV annulus and left ventricular outflow tract (LVOT).
  
  
  RESULTS
  Adequate visualization of AV cusps was achieved in 86% of patients by RT3D-TTE compared to 63% by 2D-TTE. The mean and median visualization score obtained by RT3D-TTE were higher than that by 2D-TTE. The opening of commissures was detected in (80%) of patients by RT3D-TTE compared to (34%) by 2D-TTE. AV area planimetry could be obtained in 77% of patients by RT3D-TTE compared to 43% by 2D-TTE. RT3D-TTE visualization score of AV cusps and commissures showed better interobserver agreement (Kappa: 0.62 and 0.72, respectively) than 2D-TTE (0.58 and 0.69, respectively). RT3D-TTE and 2D-TTE measurements of AV annulus and LVOT were well correlated (r = 0.85; P < 0.001) but the RT3D-TTE measurements were significantly larger than that obtained by 2D-TTE (2.05 ± 0.7 cm and 2.5 ± 0.86 cm vs 1.94 ± 0.67 cm and 1.98 ± 0.74 cm; P < 0.01).
  
  
  CONCLUSIONS
  RT3D-TTE is a feasible technique that allows comprehensive quantitative and qualitative assessment of malformed AV.
authors.affiliation: Cardiology Department, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia. ashrafanwar2000@hotmail.com
authors.forename: Ashraf M
authors.initials: AM
authors.lastname: Anwar
authors.forename: Youssef F M
authors.initials: YF
authors.lastname: Nosir
authors.forename: Ahmed N
authors.initials: AN
authors.lastname: Galal
authors.forename: Mai
authors.initials: M
authors.lastname: Al-Barakati
authors.forename: Hassan
authors.initials: H
authors.lastname: Chamsi-Pasha
mesh_terms: D000293:Adolescent; D001021:Aortic Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging*; D003199:Computer Systems; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity