3D transoesophageal echocardiography in the TAVI sizing arena: should we do it and how do we do it?

Bleakley, Caroline; Eskandari, Mehdi; Monaghan, Mark

doi:10.1530/erp-16-0041

Cited by 14 publications

(8 citation statements)

References 35 publications

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“…[ 13 ] Due to the difference between the sizes of aortic valve 3 leaflets, the use of 2D-TTE imaging in assessing aortic annulus based on the distance between 2 valvular hinge points on a 2D-TTE image will give an inaccurate measurement. [ 14 ] Therefore, many investigators tend to use 3D-TTE imaging techniques, which give more accurate measurements during the examination. [ 15 ] Thus, the present study was designed to compare 2D-TTE and 3D-TTE measurements of the aortic annular diameter using MDCT as a gold standard.…”

Section: Discussionmentioning

confidence: 99%

The role of trans-thoracic echocardiography in the assessment of aortic annular diameter

et al. 2021

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We aimed to compare two-dimension transthoracic echocardiogram (2D-TTE) and three-dimension transthoracic echocardiogram (3D-TTE) measurements of the aortic annular diameter using multi-detector CT (MDCT) as a gold standard. This prospective observational study included 50 consecutive patients who came to the cardiology department, Al-Azhar University Hospital, New Damietta, for MDCT coronary angiography. The study was carried out in the period from July 2016 until February 2017. All patients were subjected to informed consent, clinical history, physical examination, transthoracic echocardiography 2D and 3D, and MDCT. The aortic annular areas measured by MDCT and 3D-TTE were significantly larger than areas by 2D-TTE. A good correlation ( r = 0.82) was observed between the areas obtained by 3D-TTE and MDCT; however, the correlation between the values by 2D-TTE and MDCT was rough ( r = 0.30). Eccentricity Index (EI) values in 28% of the patients were greater than 0.1, that is, the aortic annulus was elliptical. Accuracy of aortic annular diameter measurement by 3D-TTE was superior to that by 2D-TTE. Three-D TTE and MDCT revealed that the shape of the aortic annulus was elliptical in 28% to 30% respectively of study subjects. There is a strong concordance between the minimum and the maximum diameter determine by 3D-TTE and MDCT.

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Section: Discussionmentioning

confidence: 99%

The role of trans-thoracic echocardiography in the assessment of aortic annular diameter

et al. 2021

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“…The annulus itself is more intricate than appreciated on 2D and, in relation to TAVR measurements, is not actually an anatomical structure but virtual, an imagined ring tracing the basal cusp hinge points. 4 It is also usually oval, with the shortest cross-sectional diameter in the sagittal TEE plane and the longest diameter in the coronal plane. This results in almost unavoidable underestimation of annular size by 2D TEE which is based on sagittal measurements for both the annulus and LVOT.…”

Section: Annulus Complexitymentioning

confidence: 99%

3D transesophageal echocardiography in TAVR

Bleakley

Monaghan

2020

Echocardiography

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Recently, there has been an increasingly minimalistic approach to transcatheter aortic valve replacement (TAVR), with most procedures now performed under conscious sedation without real time transesophageal echocardiography (TEE) guidance. Proponents of echo should not feel discouraged by this; it is the initial insights that were gained with procedural TEE during the early years of TAVR that have allowed the procedure's gradual maturation and sophistication. Experienced centers that have promoted extensive TAVR TEE programs continue to maximize the benefits of echocardiography in both procedural planning and execution. Critical to this is the understanding of 3D TEE, allowing the annulus to be sized accurately, relevant neighboring anatomy defined, and complications flagged. This review will outline the current application of 3D TEE in TAVR and discuss challenges and opportunities for 3D echocardiography in this field. 2 | PREPROCEDURE 2.1 | 3D in TAVR planning-zoom, full volume, or live? 3D imaging can be thought of as a virtual representation of how a structure would look geometrically if held in your hand, but not necessarily how it would look aesthetically. In echo, this is achieved with a matrix array probe to acquire volumes of ultrasound data composed of voxels; the larger the voxel, the poorer the resolution. A matrix array probe has several thousand piezoelectric elements and can steer a scan line in lateral, elevation, and azimuth planes generating a 3D image. Line density impacts the spatial resolution and, together with gain and compression settings, should be optimized in 2D prior to attempting 3D acquisition. There are 3 possible modes of 3D acquisition; live, zoom, and full volume. Live 3D is often seen as limited in structural echocardiography as

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“…[23][24][25][26] At least some of this difference may be related to the lower spatial resolution of 3D TEE at the time, image dropout secondary to significant calcification at the annulus or aortic valve, and center experience. 27 Notably, heavy aortic calcification limits 3D TEE evaluation of planimetry and annulus measurements due to image dropout. TEE with 3D and automated software (see Figure 3C), may ultimately provide pre-TAVR patients with 'one-stop shopping' for the evaluation of the entire aortic apparatus with excellent temporal and good spatial resolution, while avoiding contrast and radiation.…”

Section: Transcatheter Aortic Valve Replacementmentioning

confidence: 99%

Interventional Echocardiography: Field of Advanced Imaging to Support Structural Heart Interventions

Arjoon¹,

Ashley²,

Sugeng³

2018

US Cardiology Review

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Multimodality imaging, particularly echocardiography, is paramount in planning and guiding structural heart disease interventions. Transesophageal echocardiography remains unique in its ability to provide real-time 2D and 3D imaging of valvular heart disease and anatomic cardiac defects, which directly impacts the strategy and outcome of these procedures. This review summarizes the role of transesophageal echocardiography in patients undergoing the most common structural heart disease interventions.

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3D transoesophageal echocardiography in the TAVI sizing arena: should we do it and how do we do it?

Cited by 14 publications

References 35 publications

The role of trans-thoracic echocardiography in the assessment of aortic annular diameter

The role of trans-thoracic echocardiography in the assessment of aortic annular diameter

3D transesophageal echocardiography in TAVR

Interventional Echocardiography: Field of Advanced Imaging to Support Structural Heart Interventions

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