title: Two-dimensional transesophageal echocardiography for aortic annular sizing in patients undergoing transcatheter aortic valve implantation.
abstract: BACKGROUND
  Accurate preoperative assessment of the aortic annulus dimension is crucial for successful transcatheter aortic valve implantation (TAVI). In this study we examined the accuracy of a novel method using two-dimensional transesophageal echocardiography (2D-TEE) for measurement of the aortic annulus.
  
  
  METHODS
  We evaluated the theoretical impact of the measurement of the annulus diameter and area using the circumcircle of a triangle method on the decision to perform the procedure and choice of the prosthesis size.
  
  
  RESULTS
  Sixty-three consecutive patients were scheduled for TAVI. Mean age was 82 ± 4 years, and 25 patients (55.6 %) were female. Mean aortic annulus diameter was 20.3 ± 2.2 mm assessed by TEE on the mid-esophageal long-axis view and 23.9 ± 2.3 mm using CT (p < 0.001). There was a tendency for the TEE derived areas using the new method to be higher (p < 0.001). The TEE measurements were on average 42.33 mm(2) higher than the CT measurements without an evidence of a systematic over- or under-sizing (p = 1.00). Agreement between TEE and CT chosen valve sizes was good overall (kappa = 0.67 and weighted kappa = 0.71). For patients who turned out to have no AR, the two methods agreed in 84.6 % of patients.
  
  
  CONCLUSIONS
  CT remanis the gold standard in sizing of the aortic valve annulus. Nevertheless, sizing of the aortic valve annulus using TEE derived area may be helpful. The impact of integration of this method in the algorithm of aortic annulus sizing on the outcome of patients undergoing TAVI should be examined in future studies.
authors.affiliation: Internal Medicine Centre, Cardiology Department, Rostock University Clinic, Ernst-Hyedemann- Street 6, 18057, Rostock, Germany. mohammad_sherif@hotmail.com.
authors.forename: Mohammad A
authors.initials: MA
authors.lastname: Sherif
authors.affiliation: Internal Medicine Centre, Cardiology Department, Rostock University Clinic, Ernst-Hyedemann- Street 6, 18057, Rostock, Germany.
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Ince
authors.affiliation: I. Internal Medicine Clinic, Cardiology Department, Wuerzburg University Clinic, Wuerzburg, Germany.
authors.forename: Octavian
authors.initials: O
authors.lastname: Maniuc
authors.affiliation: I. Internal Medicine Clinic, Cardiology Department, Wuerzburg University Clinic, Wuerzburg, Germany.
authors.forename: Therese
authors.initials: T
authors.lastname: Reiter
authors.affiliation: I. Internal Medicine Clinic, Cardiology Department, Wuerzburg University Clinic, Wuerzburg, Germany.
authors.forename: Wolfram
authors.initials: W
authors.lastname: Voelker
authors.affiliation: I. Internal Medicine Clinic, Cardiology Department, Wuerzburg University Clinic, Wuerzburg, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Ertl
authors.affiliation: Internal Medicine Centre, Cardiology Department, Rostock University Clinic, Ernst-Hyedemann- Street 6, 18057, Rostock, Germany.
authors.forename: Alper
authors.initials: A
authors.lastname: Öner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001021:Aortic Valve / Q000000981:diagnostic imaging*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000628:therapy*; D063126:Balloon Valvuloplasty; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D017548:Echocardiography, Transesophageal; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D015588:Observer Variation; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome