title: Aortic annular sizing for transcatheter aortic valve replacement using cross-sectional 3-dimensional transesophageal echocardiography.
abstract: OBJECTIVE
  This study compared cross-sectional three-dimensional (3D) transesophageal echocardiography (TEE) to two-dimensional (2D) TEE as methods for predicting aortic regurgitation after transcatheter aortic valve replacement (TAVR).
  
  
  BACKGROUND
  Data have shown that TAVR sizing using cross-sectional contrast computed tomography (CT) parameters is superior to 2D-TEE for the prediction of paravalvular aortic regurgitation (AR). Three-dimensional TEE can offer cross-sectional assessment of the aortic annulus but its role for TAVR sizing has been poorly elucidated.
  
  
  METHODS
  All patients had severe symptomatic aortic stenosis and were treated with balloon-expandable TAVR in a single center. Patients studied had both 2D-TEE and 3D imaging (contrast CT and/or 3D-TEE) of the aortic annulus at baseline. Receiver-operating characteristic curves were generated for each measurement parameter using post-TAVR paravalvular AR moderate or greater as the state variable.
  
  
  RESULTS
  For the 256 patients studied, paravalvular AR moderate or greater occurred in 26 of 256 (10.2%) of patients. Prospectively recorded 2D-TEE measurements had a low discriminatory value (area under the curve = 0.52, 95% confidence interval: 0.40 to 0.63, p = 0.75). Average cross-sectional diameter by CT offered a high degree of discrimination (area under the curve = 0.82, 95% confidence interval: 0.73 to 0.90, p < 0.0001) and mean cross-sectional diameter by 3D-TEE was of intermediate value (area under the curve = 0.68, 95% confidence interval: 0.54 to 0.81, p = 0.036).
  
  
  CONCLUSIONS
  Cross-sectional 3D echocardiographic sizing of the aortic annulus dimension offers discrimination of post-TAVR paravalvular AR that is significantly superior to that of 2D-TEE. Cross-sectional data should be sought from 3D-TEE if good CT data are unavailable for TAVR sizing.
authors: Cedars-Sinai Heart Institute, Los Angeles, CA 90048, USA.
authors: Hasan
authors: H
authors: Jilaihawi
authors: Niraj
authors: N
authors: Doctor
authors: Mohammad
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authors: Chakravarty
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authors: Shiota
authors: Raj R
authors: RR
authors: Makkar
mesh_terms: D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000209:etiology; D001024:Aortic Valve Stenosis / Q000601:surgery; D004452:Echocardiography; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D006350:Heart Valve Prosthesis; D006801:Humans; D012372:ROC Curve; D014057:Tomography, X-Ray Computed