Article

Measurement of the aortic annulus size by real-time three-dimensional transesophageal echocardiography

Department of Cardiology, West-German Heart Center Essen, University of Duisburg-Essen, Germany.
Minimally invasive therapy & allied technologies: MITAT: official journal of the Society for Minimally Invasive Therapy (Impact Factor: 1.27). 04/2011; 20(2):85-94. DOI: 10.3109/13645706.2011.557385
Source: PubMed

ABSTRACT

We sought to determine the level of agreement and the reproducibility of two-dimensional (2D) transthoracic (2D-TTE), 2D transesophageal (2D-TEE) and real-time three-dimensional (3D) transesophageal echocardiography (RT3D-TEE) for measurement of aortic annulus size in patients referred for transcatheter aortic valve implantation (TAVI). Accurate preoperative assessment of the dimensions of the aortic annulus is critical for patient selection and successful implantation in those undergoing TAVI for severe aortic stenosis (AS). Annulus size was measured using 2D-TTE, 2D-TEE and RT3D-TEE in 105 patients with severe AS referred for TAVI. Agreement between echocardiographic methods and interobserver variability was assessed using the Bland-Altman method and regression analysis, respectively. The mean aortic annuli were 21,7 ± 3 mm measured with 2D-TTE, 22,6 ± 2,8 mm with 2D-TEE and 22,3 ± 2,9 mm with RT3D-TEE. The results showed a small but significant mean difference and a strong correlation between the three measurement techniques (2D-TTE vs. 2D-TEE mean difference 0,84 ± 1,85 mm, r = 0,8, p < 0,0001; 2D-TEE vs. 3D-TEE 0,27 ± 1,14 mm, r = 0,91, p < 0,02; 2D-TTE vs. 3D-TEE 0,58 ± 2,21 mm, r = 0,72, p = 0,02); however, differences between measurements amounted up to 6,1 mm. Interobserver variability for 2D-TTE and 2D-TEE was substantially higher compared with RT3D-TEE. We found significant differences in the dimensions of the aortic annulus measured by 2D-TTE, 2D-TEE and RT3D-TEE. Thus, in patients referred for TAVI, the echocardiographic method used may have an impact on TAVI strategy.

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Available from: Rolf Alexander Jánosi, Feb 21, 2015
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    • "A second lesson learned while gaining more TAVI experience is that 2D TEE does not respect the 3D oval shape of the aortic annulus and might lead to imprecise aortic annulus diameter measurements [6] [16] [17]. Three-dimensional TEE becomes more and more available and seems to better reflect the annular anatomy than 2D TEE [18] [19] [20] [21], and is a useful tool for aortic annulus diameter measurement. In addition, MSCT has been established as a technique for precise measurement of the complex 3D geometry of the aortic annulus including its calcification [6–10, 22]. "
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