Sensitivity and specificity of transesophageal echocardiography for determination of aortic valve morphology

Espinal, Miguel; Fuisz, Anthon; Nanda, Navin C.; Aaluri, Srinivasa R.; Mukhtar, Osman; Sekar, Padmini

doi:10.1067/mhj.2000.103843

Cited by 43 publications

(26 citation statements)

References 7 publications

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“…The evaluation was retrospective and prior-to-surgery. The sensitivity was cited as 87% and the specificity as 91% [3]. There has not been any study in the literature, to-date, describing the usefulness of a combination of TTE and TEE in aortic valve morphology analysis.…”

Section: Discussionmentioning

confidence: 99%

“…However, a sub-optimal acoustic window limits its diagnostic capability in a considerable proportion of patients. Transesophageal echocardiogram (TEE) can overcome this limitation since it has greater sensitivity and specificity [3]. Diagnosis of bicuspid aortic valve (BAV) is important because it identifies patients with high risk of valvular and aortic complications [4].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Aortic valve morphology definition with transthoracic combined with transesophageal echocardiography in a population with high prevalence of bicuspid aortic valve

Alegret

Palazón

Durán

et al. 2005

Int J Cardiovasc Imaging

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Aortic valve morphology definition with transthoracic combined with transesophageal echocardiography in a population with high prevalence of bicuspid aortic valve

Alegret

Palazón

Durán

et al. 2005

Int J Cardiovasc Imaging

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“…Two-dimensional echocardiography has a reported a sensitivity and specificity for bicuspid aortic valve diagnosis of 92% and 96%, respectively (15). Three-dimensional echocardiography has also been shown to be a reliable technique for defining the morphological details of bicuspid aortic valves, with precision comparable to anatomicopathologic examination (16), and transesophageal echocardiography has also been reported to have a higher degree of sensitivity and specificity than the transthoracic route (17). Ideally, MR images in this study would have been compared to findings at surgery or to a pathology specimen; however this was not possible as the majority of our patients did not undergo subsequent surgery or resection of the aortic valve.…”

Section: Discussionmentioning

confidence: 99%

Steady‐state free‐precession (SSFP) cine MRI in distinguishing normal and bicuspid aortic valves

Gleeson

Mwangi

Horgan

et al. 2008

Magnetic Resonance Imaging

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Purpose: To assess the diagnostic sensitivity and specificity of double-oblique true fast imaging with steady-state precession (SSFP) cine MRI in distinguishing normal and bicuspid aortic valves. Materials and Methods:Echocardiograms on patients referred for MRI of the heart and thoracic aorta over a fouryear period were reviewed retrospectively. A total of 17 patients with bicuspid aortic valve were identified and compared to 21 randomly chosen control patients. All patients had double-oblique SSFP (True FISP) cine MRI of the aortic valve independently assessed by two radiologists in a blinded fashion, and graded as bicuspid or normal. Image quality was graded as 1, 2, or 3. Discordance was resolved by consensus.Results: A total of 38 cases were reviewed (27 men, 11 women; age range ϭ 15-67 years, mean ϭ 25.33 years). Interobserver agreement was 0.97 (36/38 cases). One case of normal tricuspid valve was reported as bicuspid by both readers (false-positive). All cases in which disparity arose were rated suboptimal by both readers (grade 2 or 3). Consensus review yielded sensitivity ϭ 100%, specificity ϭ 95.2%, positive predictive value ϭ 94.4%, and negative predictive value ϭ 100%; overall diagnostic accuracy was 97.36%. Interobserver agreement was 0.97. BICUSPID AORTIC VALVE is a common congenital anomaly, with an incidence of 0.9% to 2% in the general population (1). It is associated with aortic stenosis, aortic incompetence, aortic dissection, aneurysm formation (2), infective endocarditis, and aortic coarctation (3). Up to 85% of cases of aortic coarctation have concomitant bicuspid aortic valve morphology (4) and in this group there is a significant association with ascending aortic aneurysm (5). Inheritance may be multifactorial, or autosomal dominant, and is more common in men (6). The diagnosis of bicuspid aortic valve is routinely made using cross sectional two-dimensional (2D) and Doppler echocardiography. Diagnosis is based on the demonstration of two cusps and two commissures during short-axis (SA) visualization. Features such as a single coaptation line between cusps during diastole, cusp redundancy, and eccentric valve closure support the diagnosis. ConclusionMRI is established as one of the most accurate noninvasive modalities in the study of aortic diseases (7,8). Breathhold cine sequences using steady-state free-precession (SSFP) acquisitions, e.g., true fast imaging with steady-state precession (TrueFISP) (Siemens Medical Systems, Erlangen, Germany) combine the advantage of short acquisition times and high signal-to-noise ratio, thus optimizing blood-myocardium contrast (9). Cine sequences are commonly employed to evaluate aortic valve morphology, but the diagnostic accuracy of these sequences in determining aortic valve morphology is unknown.The aim of this study was to determine the sensitivity and specificity of double-oblique TrueFISP cine MRI in distinguishing normal and bicuspid aortic valves when compared with echocardiography as a gold standard. MATERIALS AND METHODSHospital ethics comm...

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“…Comparing transthoracic echocardiography (TTE) to surgical operative records or surgical pathology demonstrated a sensitivity of 78% and a specificity of 96% for the diagnosis [31]. One study with multiplane transesophageal echocardiography (TEE) and operative records reported a sensitivity of 87% and a specificity of 91% [32]. The presence of AR and/or a dilated aorta or coarctation of the aorta in a young person suggests a bicuspid variant [33].…”

Section: Diagnosismentioning

confidence: 96%

Management of Patients With Bicuspid Aortic Valve Disease

Kiefer

Wang

Hughes

et al. 2011

Curr Treat Options Cardio Med

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Our approach to the management of the patient with a bicuspid aortic valve (BAV) takes several factors into consideration. First, is the dysfunction of the valve due to aortic stenosis (AS), aortic regurgitation (AR), or a combination of stenosis and regurgitation, and what is the severity? Next, is there aortic dilation in any of the regions (sinuses of Valsalva, sinotubular junction, tubular ascending aorta, or transverse arch) discussed in this article. In general, we follow patients with a BAV and moderate valve dysfunction (AS or AR) with yearly surveillance transthoracic echocardiography for left ventricular function, jet velocity, gradient, and valve area with AS, whereas left ventricular (LV) function and LV dimensions are monitored for patients with AR. In addition, yearly clinical evaluation for change in symptom status or functional capacity is critical. More recently, we have utilized NT-pro BNP levels to help assess patients, particularly those in whom the anatomic severity does not match the clinical symptoms (ie, the valve severity appears mild but the patient is complaining of symptoms or the valve severity seems significant but no symptoms are noted). All patients with a bicuspid valve should have evaluation of the aorta with a MRI or CT angiography at some point, as 50% of BAV patients have aortic root involvement. At our institution, cardiac MRI is preferred unless there is a contraindication, particularly in younger patients, given the cumulative radiation exposure from surveillance CT scans. Cardiac MRI also provides the added benefit of information regarding LV function, LV dimensions, and assessment of valve stenosis/regurgitation severity, thus obviating the need for echocardiographic data in those being followed with serial cardiac MRI. For those with no aortic dilatation, we tend to use only echocardiography for follow-up. For patients with mild aortic dilation, surveillance aortic imaging is usually performed every 3-5 years. However, for those with greater degrees of aortic dilation (aortic diameters >4.0 cm) or notable interval change in dimensions, then aortic imaging every year is conducted. For young adult patients with isolated aortic stenosis, balloon aortic valvuloplasty is often an effective and temporizing treatment option. In older patients with aortic stenosis or those with AR, aortic valve replacement, with or without a surgery on the aorta depending on whether concomitant dilation (aortic diameter >4.5 cm) of the aorta is present, is the preferred management strategy. In a few patients, surgery on the aortic alone may be indicated if the maximal diameter exceeds 5.0 cm.

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Sensitivity and specificity of transesophageal echocardiography for determination of aortic valve morphology

Cited by 43 publications

References 7 publications

Aortic valve morphology definition with transthoracic combined with transesophageal echocardiography in a population with high prevalence of bicuspid aortic valve

Aortic valve morphology definition with transthoracic combined with transesophageal echocardiography in a population with high prevalence of bicuspid aortic valve

Steady‐state free‐precession (SSFP) cine MRI in distinguishing normal and bicuspid aortic valves

Management of Patients With Bicuspid Aortic Valve Disease

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