Three-dimensional transesophageal echocardiography is comparable to
multi-slice computed tomography for aortic annulus sizing pre
transcatheter aortic valve replacement
Abstract
Background In transcatheter aortic valve replacement (TAVR), accurate
aortic annulus measurements are essential for prosthesis sizing to
ensure procedural success. Although multi-slice computed tomography
(MSCT) is considered the gold standard for aortic annulus measurement
pre TAVR, MSCT might be contraindicated in some patients. Aim In
patients undergoing TAVR, we sought to correlate manual and newer
semi-automated three-dimensional (3D) transesophageal echocardiography
(TEE) aortic annular measurements to MSCT measurements. In addition, we
assessed the reproducibility of these 3D TEE methods. Methods
Retrospective, single centre trial involving 39 patients with severe
symptomatic aortic stenosis (AS) planned for TAVR, who underwent both
pre-procedural MSCT and pre/peri- procedural manual and semi-automated
3D TEE. Results Mean age was 85.3 ± 4.7 years. Both 3D TEE methods
highly correlated with MSCT for annular diameters (semi-automated r
=0.96, p<0.0001 and manual r=0.84, p<0.0001) and for
annular areas (semi-automated r=0.96, p<0.0001 and manual
r=0.82, p<0.0001). Inter-observer reproducibility was high for
both 3D TEE methods for annular diameters (semi-automated r=0.96,
p<0.001 and manual r=0.91, p<0.001) and annular area
(semi-automated r=0.96, p<0.0001 and manual was 0.95
p<0.0001). Conclusion Both semi-automated and manual 3D TEE
for sizing of the aortic annulus for TAVR is comparable to MSCT. 3D TEE
methods are easily reproducible. Newer semi-automated 3D TEE has the
best correlation to MSCT. 3D TEE is an excellent alternative imaging
modality for TAVR planning in patients whom MSCT is contraindicated.