title: Diagnostic accuracy of transthoracic and transesophageal echocardiography for the diagnosis of bicuspid aortic valve: comparison with operative findings.
abstract: BACKGROUND
  Bicuspid aortic valve (BAV) is associated with an increased risk of aortic valve (AV) dysfunction, aortic dissection, and infective endocarditis. Therefore, its accurate diagnosis is critical. The morphological features of AVs are generally evaluated by transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE), however, the difference in the diagnostic capability of these imaging modalities for detecting BAV remains unclear. Here, we compared these 2 methods to determine their accuracy, and to clarify each role in the diagnosis of BAV.
  
  
  METHODS
  This blind study evaluated 126 patients (age, 70.3 +/- 7.8 years) who subsequently underwent AV replacement. The number of AV cusps of each patient was estimated by TTE and TEE and compared to the number of AV written in the operative record. Patients with poor echocardiographic images were not excluded.
  
  
  RESULTS
  Surgical findings showed 97 tricuspid AVs and 29 BAVs. The sensitivity, specificity, and accuracy for the diagnosis of BAV were 61%, 81%, and 77%, respectively, for TTE and 86%, 90%, and 89%, respectively, for TEE. The accuracy of TEE was significantly higher than that of TTE (p = 0.016). In non-calcified AVs, the accuracy of TTE was similar to that of TEE (96%, each) whereas in calcified AVs, TTE had a lower accuracy than TEE (72% vs 87%, p = 0.011). The feasibility was significantly higher for TEE than for TTE (98% vs 90%, p = 0.003).
  
  
  CONCLUSIONS
  TEE provides higher accuracy and feasibility than TTE in the diagnosis of BAV, and it should therefore be indicated when morphological features of AVs cannot be evaluated by TTE.
authors.affiliation: Department of Internal Medicine and Cardiology, Osaka City University, Graduate School of Medicine, Japan. rute55@hotmail.com
authors.forename: Hisateru
authors.initials: H
authors.lastname: Takeda
authors.affiliation: Department of Cardiology, Midori Hospital, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Muro
authors.affiliation: Department of Internal Medicine and Cardiology, Osaka City University, Graduate School of Medicine, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Saito
authors.affiliation: Department of Cardiovascular Medicine, Nishinomiya Watanabe Cardiovascular Center, Japan.
authors.forename: Eiichi
authors.initials: E
authors.lastname: Hyodo
authors.affiliation: Department of Internal Medicine and Cardiology, Osaka City University, Graduate School of Medicine, Japan.
authors.forename: Shoichi
authors.initials: S
authors.lastname: Ehara
authors.affiliation: Department of Internal Medicine and Cardiology, Osaka City University, Graduate School of Medicine, Japan.
authors.forename: Akihisa
authors.initials: A
authors.lastname: Hanatani
authors.affiliation: Department of Internal Medicine and Cardiology, Osaka City University, Graduate School of Medicine, Japan.
authors.forename: Kenei
authors.initials: K
authors.lastname: Shimada
authors.affiliation: Department of Cardiovascular Surgery, Osaka City University, Graduate School of Medicine, Japan.
authors.forename: Shigefumi
authors.initials: S
authors.lastname: Suehiro
authors.affiliation: Department of Internal Medicine and Cardiology, Osaka City University, Graduate School of Medicine, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Yoshiyama
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D000082882:Bicuspid Aortic Valve Disease; D004452:Echocardiography / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged