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DOI: 10.1055/s-0031-1297488
Three dimensional transesophageal echocardiography in prosthesis sizing for transcatheter aortic valve implantation
Aims: Comprehensive screening of patients prior to transcatheter aortic valve implantation is crucial for procedural success. Accurate measuring of the aortic annulus diameter is an important determinant of prosthesis size. This analysis compares aortic annulus diameter measures obtained by 2D and 3D TEE, as well as the impact on selection of prosthesis size.
Methods: All patients underwent TEE as part of TAVI screening. Measurements were evaluated by two independent, blinded observers. In 2D TEE, aortic annulus was measured at the insertion of the leaflets in midsystole from the 120° –140° long axis view. 3D data were evaluated offline using multiple plane reconstruction in early systole: two orthogonal planes bisecting the long axis in parallel and a third transverse plane bisecting the aortic annulus at the insertion points of all three aortic cusps as the short axis view. Aortic annulus was measured as the largest possible diameter in an idealized three chamber view using plane correction in short axis planes. The percentage of cases, in which 2D and 3D TEE correctly predicted final prosthesis size selection, was calculated.
Results: 29 patients were analyzed (59% female, age 80±6). TAVI procedure was successful in 27 patients (21 transfemoral, 8 transapical). There was a correlation of aortic annulus diameters from 2D and 3D TEE (r=0.617; p<0.001). Measured diameters were significantly larger on 3D vs. 2D TEE (23.0±1.6 vs. 21.3±1.9mm; p<0.001). Final prosthesis size was correctly predicted in 55% and 83% by 2D TEE and 3D TEE respectively.
Conclusion: Measurement of the aortic annulus for TAVI by 3D yields significantly larger diameters than 2D TEE. Use of 3D TEE offers further information in selection of prosthesis size.