Planimetry of orifice area in aortic stenosis using multiplane transesophageal ecocardiography

Hoffman, Rainer; Flachskampf, Frank A.; Hanrath, Peter

doi:10.1016/0735-1097(93)90060-e

Cited by 136 publications

(46 citation statements)

References 17 publications

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“…These data are in accordance with reports on multiplane TEE which showed that structures with a complex spatial orientation such as aortic valve, ascending aorta, aortic arch, and coronary arteries are more easily and completely assessed with multiplane TEE [7,[13][14][15][16][17][18] . Thus, multiplane TEE appears to be an ideal method to give detailed anatomical information about the morphology of a dissection, and can also show the consequences and complications of proximal extension.…”

Section: Discussionsupporting

confidence: 81%

Rapid Diagnosis and Management of Thoracic Aortic Dissection and Intramural Haematoma: a Prospective Study of Advantages of Multiplane vs. Biplane Transoesophageal Echocardiography

Pepi¹,

Campodonico²,

Galli³

et al. 2000

European Journal of Echocardiography

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Aims:The purposes of this study were to compare the accuracy of multiplane vs. biplane transoesophageal echocardiography (TEE) in the diagnosis of aortic dissection and aortic intramural haematoma, and to test whether these techniques provide all the diagnostic information required to make management decisions. Methods and Results:Fifty-eight consecutive patients with clinically suspected aortic dissection were studied with multiplane TEE; all cases who required surgery underwent intraoperative monitoring with multiplane TEE.The following multiplane TEE data were analysed: the angle between current and 0 plane at which each view was obtained; the success rate in the evaluation of true and false lumen, entry tear, coronary artery involvement, aortic regurgitation, pericardial effusion. Advantages of multiplane over biplane TEE have been evaluated by the demonstration of usefulness of views obtained in planes other than 0 -20 or 70 -110 , assuming that with manipulation of a biplane probe a 20 arc could be added to the conventional horizontal and vertical planes.On the basis of TEE findings, aortic dissection was confirmed in 36 cases (18 type A, 12 type B, six intramural haematoma). The specificity and sensitivity of TEE in terms of the presence or absence of aortic dissection or intramural haematoma were 100%. An additional clinical value of multiplane over biplane TEE in the evaluation of ascending aorta, aortic arch, entry tears and coronary artery involvement was demonstrated. All cases with type A aortic dissection or intramural haematoma involving the ascending aorta had an operation that was performed immediately after the diagnosis (hospital mortality, 13%). Patients with type B aortic dissection were treated medically; 25% of these cases were operated later (hospital mortality, 0%). Conclusions:Multiplane and biplane TEE have excellent and similar accuracies in the evaluation of aortic dissection and intramural haematoma. Multiplane TEE improves the visualization of coronary arteries, aortic arch and entry tears; it appears to be an ideal method as the sole diagnostic approach before surgery in type A aortic dissection.

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Section: Discussionsupporting

confidence: 81%

Rapid Diagnosis and Management of Thoracic Aortic Dissection and Intramural Haematoma: a Prospective Study of Advantages of Multiplane vs. Biplane Transoesophageal Echocardiography

Pepi¹,

Campodonico²,

Galli³

et al. 2000

European Journal of Echocardiography

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“…Other diagnostic tools should be considered to assess morphology and hemodynamics of the stenotic valve. This may include transesophageal echocardiography, 31 magnetic resonance imaging, 32 and, rarely, cardiac catheterization, 33 as outlined in the American Heart Association/ American College of Cardiology and European Society of Cardiology guidelines. 10 -12 Several additional echocardiographic parameters have been proposed for a better definition of the severity of aortic stenosis and imminent risk (energy loss index, 34,35 stroke work loss, 36,37 resistance, 38 and valvuloarterial impedance 39,40 ), but their utility and prognostic impact still must be proven in larger-scale, prospective studies.…”

Section: Discussionmentioning

confidence: 99%

Outcome of Patients With Low-Gradient “Severe” Aortic Stenosis and Preserved Ejection Fraction

et al. 2011

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Background— Retrospective studies have suggested that patients with a low transvalvular gradient in the presence of an aortic valve area <1.0 cm 2 and normal ejection fraction may represent a subgroup with an advanced stage of aortic valve disease, reduced stroke volume, and poor prognosis requiring early surgery. We therefore evaluated the outcome of patients with low-gradient “severe” stenosis (defined as aortic valve area <1.0 cm 2 and mean gradient ≤40 mm Hg) in the prospective Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. Methods and Results— Outcome in patients with low-gradient “severe” aortic stenosis was compared with outcome in patients with moderate stenosis (aortic valve area 1.0 to 1.5 cm 2 ; mean gradient 25 to 40 mm Hg). The primary end point of aortic valve events included death from cardiovascular causes, aortic valve replacement, and heart failure due to aortic stenosis. Secondary end points were major cardiovascular events and cardiovascular death. In 1525 asymptomatic patients (mean age, 67±10 years; ejection fraction, ≥55%), baseline echocardiography revealed low-gradient severe stenosis in 435 patients (29%) and moderate stenosis in 184 (12%). Left ventricular mass was lower in patients with low-gradient severe stenosis than in those with moderate stenosis (182±64 versus 212±68 g; P <0.01). During 46 months of follow-up, aortic valve events occurred in 48.5% versus 44.6%, respectively ( P =0.37; major cardiovascular events, 50.9% versus 48.5%, P =0.58; cardiovascular death, 7.8% versus 4.9%, P =0.19). Low-gradient severe stenosis patients with reduced stroke volume index (≤35 mL/m 2 ; n=223) had aortic valve events comparable to those in patients with normal stroke volume index (46.2% versus 50.9%; P =0.53). Conclusions— Patients with low-gradient “severe” aortic stenosis and normal ejection fraction have an outcome similar to that in patients with moderate stenosis.

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“…A Cc below 1 in mitral stenosis implies that effective valve area is less than anatomic valve area; however, in aortic stenosis Cc was established empirically as 1, indicating that AVAe is equal to AVAa. Several studies of the correlation between AVAe estimated by Doppler echocardiography and valve area estimated by cardiac catheterization, TEE, computed tomography and magnetic resonance demonstrated that AVAa is greater than AVAe, because AVAe is calculated using the maximal velocity at the vena contracta, a hydrodynamic area located above AVAa [12] [18]- [23]. Clavel et al [24] studied with computed tomography and echocardiography patients with aortic stenosis and found a modest correlation [32] [33].…”

Section: Discussionmentioning

confidence: 99%

“…A multiplane Toshiba 5 MHz transducer was used and planimetry of the aortic valve was obtained from the short-axis view [12]. The view was considered adequate for planimetry if the aorta had a circular shape and all cusps were visualized simultaneously.…”

Section: Transesophageal Echocardiographymentioning

confidence: 99%

Estimation of Contraction Coefficient of Gorlin Equation for Assessment of Aortic Valve Area in Aortic Stenosis

Migliore¹,

Adaniya²,

Barranco³

et al. 2017

WJCD

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Background: The Gorlin equation is the reference method for the assessment of aortic valve area in aortic stenosis and is calculated using a constant, called the coefficient of contraction, which is empirically assumed to be 1. This coefficient is the ratio of effective aortic area to anatomic aortic area, and a value of 1 indicates that both are the same. The purpose of this study was to estimate the actual coefficient of contraction in patients with aortic stenosis and to evaluate its impact on aortic area as calculated by the Gorlin equation. Methods: We studied 17 patients with moderate to severe aortic stenosis. Effective aortic area was calculated using the continuity equation. Anatomic aortic area was obtained by planimetry with transesophageal echocardiography. Aortic valve area by the Gorlin equation was calculated from echocardiography data. The coefficient of contraction was derived as above. Results: The coefficient of contraction was inversely related to the pressure recovery. Effective area was correlated with anatomic area (r = 0.86, P < 0.01) but there was a high mean difference (0.22 ± 0.14 cm 2 ). Aortic area by the Gorlin equation was not correlated with anatomic area, but the correlation became significant when the Gorlin equation was corrected for coefficient of contraction and pressure recovery. Conclusions: Using a coefficient of contraction of 1 in the Gorlin equation gives a poor correlation with anatomic area. Using the calculated coefficient of contraction for each patient and the mean gradient for pressure recovery improves the correlation with anatomic area. These facts could be taken in account when Gorlin equation is considered as the reference method.

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Planimetry of orifice area in aortic stenosis using multiplane transesophageal ecocardiography

Abstract: Multiplane transesophageal echocardiography is a practical and accurate clinical tool for the assessment of the severity of aortic stenosis.

Cited by 136 publications

References 17 publications

Rapid Diagnosis and Management of Thoracic Aortic Dissection and Intramural Haematoma: a Prospective Study of Advantages of Multiplane vs. Biplane Transoesophageal Echocardiography

Rapid Diagnosis and Management of Thoracic Aortic Dissection and Intramural Haematoma: a Prospective Study of Advantages of Multiplane vs. Biplane Transoesophageal Echocardiography

Outcome of Patients With Low-Gradient “Severe” Aortic Stenosis and Preserved Ejection Fraction

Estimation of Contraction Coefficient of Gorlin Equation for Assessment of Aortic Valve Area in Aortic Stenosis

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