title: Is real time 3D transesophageal echocardiography a feasible approach to detect coronary ostium during transapical aortic valve implantation?
abstract: OBJECTIVE
  Transapical aortic valve implantation (TAVI) may lead to obstruction of coronary arteries during deployment. To prevent this, it is essential to determine the distance of the coronary ostium to the aortic annulus prior to valve placement. Multidetector computed tomography (MDCT) commonly is used to determine these measurements, but even marginal exposure to contrast agents can result in acute kidney injury in this high-risk group of multi-morbid patients. The aim of the study was to determine the feasibility of real-time 3D transesophageal echocardiography (RT 3D TEE) as the first-choice technique for noninvasive evaluation of the coronary ostium during TAVI.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Fifty patients underwent MDCT the evening before surgery. RT 3D TEE was performed intraoperatively before valve deployment. The dataset from both of these examinations was digitally stored and evaluated. MDCT was performed in nonanesthetized patients; however, in the RT 3D TEE group, general anesthesia was established.
  
  
  RESULTS
  The distances from the right coronary artery and the left coronary artery ostium were measured retrospectively. Bland-Altman Plots and linear regression analysis showed excellent correlation between the 2 methodologies; intraobserver and interobserver variance were calculated using analysis of variance. Krippendorff's α indicated excellent agreement between the 2 observers (0.96 and 0.98) as well as between RT 3D TEE and MDCT (0.97 and 0.98).
  
  
  CONCLUSIONS
  The observations showed that RT 3D TEE reliably can measure the coronary ostium distance from the aortic annulus. It is feasible and an alternative method for evaluating these measurements and thereby preventing contrast exposure during MDCT, which may jeopardize the safety of patients with pre-existing renal disease.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine II, Heartcentre, University of Leipzig, Leipzig, Germany. chirojit.mukherjee@med.uni-leipzig.de
authors.forename: Chirojit
authors.initials: C
authors.lastname: Mukherjee
authors.forename: Frederik
authors.initials: F
authors.lastname: Hein
authors.forename: David
authors.initials: D
authors.lastname: Holzhey
authors.forename: Lehmkuhl
authors.initials: L
authors.lastname: Lukas
authors.forename: Meinhard
authors.initials: M
authors.lastname: Mende
authors.forename: Udo X
authors.initials: UX
authors.lastname: Kaisers
authors.forename: Joerg
authors.initials: J
authors.lastname: Ender
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000601:surgery*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D016014:Linear Models; D008297:Male; D015588:Observer Variation; D012984:Software; D014057:Tomography, X-Ray Computed
keywords: 3D transesophageal echocardiography; coronary ostium; multidetector computed tomography; transapical aortic valve implantation