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Husser O, Holzamer A, Resch M, Endemann DH, Nunez J, Bodi V, Schmid C, Riegger GAJ, Gössmann H, Hamer O, Stroszczynski C, Luchner A, Hilker M, Hengstenberg C. Prosthesis sizing for transcatheter aortic valve implantation--comparison of three dimensional transesophageal echocardiography with multislice computed tomography. Int J Cardiol 2013; 168:3431-8. [PMID: 23688431 DOI: 10.1016/j.ijcard.2013.04.182] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 04/13/2013] [Accepted: 04/19/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND The complex anatomy of the aortic annulus warrants the use of three dimensional (3D) modalities for prosthesis sizing in transcatheter aortic valve implantation (TAVI). Multislice computed tomography (MSCT) has been used for this purpose, but its use may be restricted because of contrast administration. 3D transesophageal echocardiography (3D-TEE) lacks this limitation and data on comparison with MSCT is scarce. We compared 3D-TEE with MSCT for prosthesis sizing in TAVI. METHODS Aortic annulus diameters in the sagittal and coronal plane and annulus areas in 3D-TEE and MSCT were compared in 57 patients undergoing TAVI. Final prosthesis size was left at the operator's discretion and the agreement with 3D-TEE and MSCT was calculated. RESULTS Sagittal diameters on 3D-TEE and MSCT correlated well (r=.754, p<.0001) and means were comparable (22.3±2.1 vs. 22.5±2.3 mm; p=0.2; mean difference: -0.3 mm [-3.3-2.8]). On 3D-TEE, coronal diameter and annulus area were significantly smaller (p<.0001 for both) with moderate correlation (r=0.454 and r=0.592). Interobserver variability was comparable for both modalities. TAVI was successful in all patients with no severe post-procedural insufficiency. Final prosthesis size was best predicted by sagittal annulus diameters in 84% and 79% by 3D-TEE and MSCT, respectively. Agreement between both modalities was 77%. CONCLUSIONS Annulus diameters and areas for pre-procedural TAVI assessment by 3D-TEE are significantly smaller than MSCT with exception of sagittal diameters. Using sagittal diameters, both modalities predicted well final prosthesis size and excellent procedural results were obtained. 3D-TEE can thus be a useful alternative in patients with contraindications to MSCT.
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Affiliation(s)
- Oliver Husser
- Klinik und Poliklinik für Innere Medizin II, University of Regensburg Medical Center, Regensburg, Germany; Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, München, Germany; Deutsches Zentrum für Herz- und Kreislauf-Forschung e.V., Partner Site Munich Heart Alliance, Munich, Germany.
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González-Cánovas C, Muñoz-Esparza C, Oliva MJ, González-Carrillo J, López-Cuenca Á, Saura D, García-Navarro M, Espinosa MD, Caro C, Caballero L, Valdés M, de la Morena G. Estenosis aórtica grave con bajo gradiente y fracción de eyección normal: ¿una cuestión de mala clasificación? Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2012.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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González-Cánovas C, Muñoz-Esparza C, Oliva MJ, González-Carrillo J, López-Cuenca Á, Saura D, García-Navarro M, Espinosa MD, Caro C, Caballero L, Valdés M, de la Morena G. Severe aortic valve stenosis with low-gradient and preserved ejection fraction: a misclassification issue? ACTA ACUST UNITED AC 2012; 66:255-60. [PMID: 24775614 DOI: 10.1016/j.rec.2012.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 08/30/2012] [Indexed: 10/27/2022]
Abstract
INTRODUCTION AND OBJECTIVES Low-gradient severe aortic stenosis with preserved ejection fraction is a controversial entity. Misclassification of valvulopathy severity could explain the inconsistencies reported in the prognosis of these patients. Planimetry of the aortic area using three-dimensional transesophageal echocardiography could clear up these doubts. The objectives were to assess the agreement between measurements of the valvular aortic area by continuity equation in transthoracic echocardiography and that obtained through planimetry with three-dimensional transesophageal echocardiography in low-gradient severe aortic stenosis patients. METHODS Cross-sectional descriptive study of consecutive patients referred due to severe aortic stenosis. Patients underwent transthoracic echocardiography and three-dimensional transesophageal echocardiography. Paradoxical low-gradient severe aortic stenosis was defined by the presence in the transthoracic echocardiography of aortic valve area<1 cm(2), mean ventricular gradient<40 mmHg, and ejection fraction ≥ 50%. Concordance between the two techniques was evaluated. RESULTS Of 212 consecutive severe aortic stenosis patients evaluated, 63 cases (29.7%) fulfilled the paradoxical low-gradient inclusion criteria. We obtained three-dimensional aortic valve planimetry in 61 (96.8%) of those patients. In 52 patients (85.2%), aortic valve area by transesophageal echocardiography was <1 cm(2). The intraclass correlation coefficient between the two methods was 0.505 (95% confidence interval, 0.290-0.671; P<.001). CONCLUSIONS Paradoxical low-gradient severe aortic stenosis is an actual entity, confirmed in 85% of cases evaluated by three-dimensional transesophageal echocardiography.
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Affiliation(s)
| | - Carmen Muñoz-Esparza
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - María J Oliva
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | | | - Ángel López-Cuenca
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Daniel Saura
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Miguel García-Navarro
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - María D Espinosa
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - César Caro
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Luis Caballero
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Mariano Valdés
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Gonzalo de la Morena
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain.
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de Heer LM, Kluin J, Stella PR, Sieswerda GTJ, Th M Mali WP, van Herwerden LA, Budde RPJ. Multimodality imaging throughout transcatheter aortic valve implantation. Future Cardiol 2012; 8:413-24. [DOI: 10.2217/fca.12.19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is a novel, less-invasive technique used to treat selected patients with severe aortic valve stenosis with a high surgical risk. Noninvasive imaging before, during and after the procedure is of the utmost importance in this minimally invasive procedure. Screening of the patient and sizing of the aortic root by echocardiography and multislice computed tomography is of great importance to ensure success of the TAVI procedure. Echocardiography and fluoroscopy are essential during the procedure. During follow-up of the patients, echocardiography is important to evaluate the prosthesis function, durability and integrity. Additionally, multislice computed tomography and MRI might be helpful in the follow-up of selected cases. This article outlines the evolving role of multimodality imaging throughout TAVI in patients with severe aortic valve stenosis. It describes, in a stepwise approach, how multimodality imaging by echocardiography, angiography, multislice computed tomography and MRI enhances the TAVI procedure.
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Affiliation(s)
- Linda M de Heer
- University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - Jolanda Kluin
- University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - Pieter R Stella
- University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | | | | | | | - Ricardo PJ Budde
- University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
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Husser O, Rauch S, Endemann DH, Resch M, Nunez J, Bodi V, Hilker M, Schmid C, Riegger GA, Luchner A, Hengstenberg C. Impact of three-dimensional transesophageal echocardiography on prosthesis sizing for transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2012; 80:956-63. [DOI: 10.1002/ccd.23459] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Revised: 10/05/2011] [Accepted: 10/31/2011] [Indexed: 11/08/2022]
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Sudhakar S, Khairnar P, Nanda NC. Live/Real Time Three-Dimensional Transesophageal Echocardiography. Echocardiography 2012. [DOI: 10.1111/j.1540-8175.2011.01525.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Jayasuriya C, Moss RR, Munt B. Transcatheter Aortic Valve Implantation in Aortic Stenosis: The Role of Echocardiography. J Am Soc Echocardiogr 2011; 24:15-27. [DOI: 10.1016/j.echo.2010.11.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Indexed: 11/30/2022]
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