Quantification of aortic valve area: comparison of different methods of echocardiography with 3-D scan of the excised va
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ORIGINAL PAPER
Quantification of aortic valve area: comparison of different methods of echocardiography with 3‑D scan of the excised valve Samira Shirazi1 · Fatemeh Golmohammadi1 · Anahita Tavoosi1 · Mehrdad Salehi2 · Farnoosh Larti1 · Akram Sardari1 · Babak Geraiely1 · Mehrzad Rahmanian2 · Kianoush Saberi3 · Roya Sattarzadeh Badkoubeh1 Received: 30 July 2020 / Accepted: 18 September 2020 © Springer Nature B.V. 2020
Abstract Accurate determination of severity of aortic valve stenosis (AS) by aortic valve area (AVA) is essential for choosing the best treatment strategy. We compared AVA quantified by 4 different in vivo echocardiographic methods with AVA measured by 3D ex vivo scanning of the excised AV. The data on 38 patients who underwent aortic valve replacement were assessed. The AVA was determined by 4 echocardiographic methods of planimetry in 2D transesophageal echocardiography [planimetry (2D-TEE)], plainemetry by multiplanar reconstruction approach in 3D transesophageal echocardiography [MPR (3D-TEE)], and two continuity equation (CE) approaches; conventional CE (2D-TTE) in which left ventricular outflow tract [LVOT] area derived by LVOT diameter obtained in 2D transthoracic echocardiography and CE (3D-TEE) in which LVOT area obtained by 3D MPR. After the surgical removal of the AV, AVA was determined by 3D ex vivo scanning. Lowest AVA mean difference with 3D ex vivo scanning was found between CE (2D-TTE), followed by CE (3D-TEE). Planimetry (2D-TEE) in male patients as well as severely and non-severely calcified valves revealed a significant higher AVA mean difference with 3D ex vivo scanning than CE (2D-TTE) and CE (3D-TEE) methods. However, with a nonsignificant effect, CE (2D-TTE) and planimetry (2D-TEE) had the least mean difference with 3D ex vivo scanning possibly due to less frequent bicuspid AV in females. CE (2D-TTE) was more accurate than other methods of AVA calculation. Moreover, CE (3D-TEE) and MPR (3DTEE) methods had acceptable accuracy in comparison with planimetry (2D-TEE) for definition of AS severity. Keywords Aortic stenosis · Continuity equation · Three-dimensional echocardiography · Three-dimensional scanning
Introduction Aortic valve stenosis (AS) is the most prevalent heart valve disease in developed countries with aging as its most significant risk factor [1–4]. Surgical or transcatheter aortic valve (AV) replacement is considered the only standard treatment for severe AS which improves patients’ symptoms and * Roya Sattarzadeh Badkoubeh [email protected] 1
Cardiology Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Keshavarz Boulevard, P.O.Box: 1419733141, Tehran, Iran
2
Cardiac Surgery Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
3
Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
survival [1, 5, 6]. Accurate determination of the severity of stenosis by aortic valve area (AVA) is essential for choosing the
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