Optimal prosthesis sizing in transcatheter aortic valve implantation by exclusive use of three-dimensional transoesophageal echocardiography

• Published in: Clinical physiology and functional imaging 2016-03, Vol.36 (2), p.99-105
• Main Authors: Kretzschmar, Daniel, Lauten, Alexander, Goebel, Bjoern, Doenst, Torsten, Poerner, Tudor C., Ferrari, Markus, Figulla, Hans R., Hamadanchi, Ali
• Format: Article
• Language: English
• Subjects: 2D-transoesophageal echocardiography; 3D-transoesophageal echocardiography; Aged; Aged, 80 and over; aortic annulus; aortic stenosis; Aortic Valve - diagnostic imaging; Aortic Valve - physiopathology; Aortic Valve Insufficiency - etiology; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - physiopathology; Aortic Valve Stenosis - therapy; Cardiac Catheterization - adverse effects; Cardiac Catheterization - instrumentation; Echocardiography, Three-Dimensional; Echocardiography, Transesophageal; Female; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - instrumentation; Humans; Image Interpretation, Computer-Assisted; Male; Observer Variation; Predictive Value of Tests; Prosthesis Design; Reproducibility of Results; transcatheter aortic valve implantation; Treatment Outcome
• ISSN: 1475-0961; 1475-097X
• DOI: 10.1111/cpf.12200

Summary Purpose 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