title: Value of anatomical aortic valve area using real-time three-dimensional transoesophageal echocardiography in patients with aortic stenosis: a comparison between tricuspid and bicuspid aortic valves.
abstract: OBJECTIVE
  Accurate assessment of disease severity is critical for appropriate treatment of patients with aortic stenosis (AS). This study investigated the influence of aortic-valve morphology on the determination of anatomical aortic-valve area (AVA) in patients with AS.
  
  
  RESULTS
  This prospective study included 126 patients with AS who underwent transoesophageal echocardiography (TEE). Aortic-valve area was measured using (i) planimetric two-dimensional (2D) TEE, (ii) volumetric three-dimensional (3D) TEE, and (iii) the continuity equation (CE) obtained with transthoracic echocardiography. Of these, 20 patients also underwent contrast-enhanced multidetector computed tomography (MDCT). Aortic-valve area was measured from multiplanar reconstruction of the MDCT images. Of the 126 patients, 20 (15.9%) were diagnosed with bicuspid AS and 106 were diagnosed with tricuspid AS. There was an excellent correlation between AVAADCT and AVA3DTEE (r = 0.83, P < 0.001) and a somewhat lower correlation between AVAADCT and AVA2DTEE (r = 0.63, P = 0.006). In the tricuspid AS group, both AVA2DTEE and AVA3DTEE significantly correlated with AVACE (r = 0.63, mean difference 0.13 ± 0.24 cm(2), and r = 0.83, mean difference 0.03 ± 0.12 cm(2), respectively, both P < 0.001). In contrast, in the bicuspid AS group, AVA3DTEE significantly correlated with AVACE (r = 0.83, mean difference 0.10 ± 0.18 cm(2), P < 0.001), whereas AVA2DTEE did not (r = 0.42, mean difference 0.48 ± 0.32 cm(2), P = 0.066).
  
  
  CONCLUSIONS
  Aortic-valve morphology influenced the assessment of anatomical AVA in patients with AS, and 3D TEE is useful for assessing anatomical AVA regardless of aortic-valve morphology.
authors.affiliation: Department of Pharmacology, St Marianna University School of Medicine, Kawasaki, Japan.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Machida
authors.affiliation: Division of Cardiology, Department of Internal Medicine, St Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan heartizumo@yahoo.co.jp.
authors.forename: Masaki
authors.initials: M
authors.lastname: Izumo
authors.affiliation: Division of Cardiology, Department of Internal Medicine, St Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan.
authors.forename: Kengo
authors.initials: K
authors.lastname: Suzuki
authors.affiliation: Division of Cardiology, Department of Internal Medicine, St Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan.
authors.forename: Kihei
authors.initials: K
authors.lastname: Yoneyama
authors.affiliation: Division of Cardiology, Department of Internal Medicine, St Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Kamijima
authors.affiliation: Division of Cardiology, Department of Internal Medicine, St Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Mizukoshi
authors.affiliation: Division of Cardiology, Department of Internal Medicine, St Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Takai
authors.affiliation: Department of Radiology, St Marianna University School of Medicine, Kawasaki, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Kobayashi
authors.affiliation: Division of Cardiology, Department of Internal Medicine, St Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan.
authors.forename: Tomoo
authors.initials: T
authors.lastname: Harada
authors.affiliation: Division of Cardiology, Department of Internal Medicine, St Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan.
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Miyake
authors.affiliation: Division of Cardiology, Department of Internal Medicine, St Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Ohtaki
authors.affiliation: Department of Laboratory Medicine, St Marianna University School of Medicine, Kawasaki, Japan.
authors.forename: Sachihiko
authors.initials: S
authors.lastname: Nobuoka
authors.affiliation: Department of Pharmacology, St Marianna University School of Medicine, Kawasaki, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Matsumoto
authors.affiliation: Division of Cardiology, Department of Internal Medicine, St Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan.
authors.forename: Yoshihiro J
authors.initials: YJ
authors.lastname: Akashi
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000473:pathology; D003287:Contrast Media; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed; D014261:Tricuspid Valve / Q000000981:diagnostic imaging*
chemical_list: D003287:Contrast Media
keywords: Aortic valve stenosis; Echocardiography; Three-dimensional echocardiography