title: Optimal prosthesis sizing in transcatheter aortic valve implantation by exclusive use of three-dimensional transoesophageal echocardiography.
abstract: OBJECTIVE
  The assessment of aortic annular size is critical, and inappropriate sizing is thought to be a main reason of paravalvular aortic regurgitation. Multidetector computed tomograph is associated with the risk of contrast nephropathy. For optimal evaluation of the complex structure of the aortic annulus, three-dimensional (3D)-methods should be used. We therefore sought to determine the value of 3D-transoesophageal echocardiography (3D-TEE) for appropriate sizing.
  
  
  METHODS
  Hundred and one patients (mean age 81·4 years) with symptomatic aortic valve stenosis (AS) and high surgical risk profile (mean log. EuroScore 28·8%) being scheduled for transcatheter aortic valve implantation (TAVI) were included. 2D- and 3D-TEE were performed before the procedure to evaluate the aortic annulus diameter.
  
  
  RESULTS
  Maximum, minimum and mean (max diameter + min diameter/2) annulus diameters were 24·7, 23·1 and 23. 9 mm in 3D-TEE and compared to 22·6 mm in 2D-TEE (P<0·001; 0·07; <0·001). The interobserver variability for 3D-TEE was low with a mean difference of 0·18 mm compared to 2D-TEE with 0·59 mm. The application of 3D-TEE caused a change of prosthesis size selection in 40% of patients compared to 2D-TEE. In this study, we implanted three different types of catheter-mounted valves (Edwards-SAPIEN(™) XT valve, CoreValve(™) and JenaValve(™) ). Final angiography confirmed valve competence (mild insufficiency) in 91%, and there was no aortic regurgitation greater than moderate in the follow-up echocardiographic evaluation.
  
  
  CONCLUSIONS
  Assessment of aortic annulus dimensions for TAVI size selection can safely be performed with 3D-TEE only. Based on our results with significantly higher annulus diameter compared to 2D-TEE, we recommend 3D-TEE to reduce prosthesis undersizing.
authors.affiliation: Department of Internal Medicine I, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Kretzschmar
authors.affiliation: Department of Internal Medicine I, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Lauten
authors.affiliation: Department of Internal Medicine I, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany.
authors.forename: Bjoern
authors.initials: B
authors.lastname: Goebel
authors.affiliation: Department of Heart Surgery, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany.
authors.forename: Torsten
authors.initials: T
authors.lastname: Doenst
authors.affiliation: Department of Internal Medicine I, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany.
authors.forename: Tudor C
authors.initials: TC
authors.lastname: Poerner
authors.affiliation: Department of Internal Medicine I, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Ferrari
authors.affiliation: Department of Internal Medicine I, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany.
authors.forename: Hans R
authors.initials: HR
authors.lastname: Figulla
authors.affiliation: Department of Internal Medicine I, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany.
authors.forename: Ali
authors.initials: A
authors.lastname: Hamadanchi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001022:Aortic Valve Insufficiency / Q000209:etiology; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D015588:Observer Variation; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D015203:Reproducibility of Results; D016896:Treatment Outcome
keywords: 2D-transoesophageal echocardiography; 3D-transoesophageal echocardiography; aortic annulus; aortic stenosis; transcatheter aortic valve implantation