Three-dimensional surface area of the aortic valve orifice by three- dimensional echocardiography

Clinical validation of a novel index for assessment of aortic stenosis

S. Ge, Jr Warner J.G., T. P. Abraham, N. D. Kon, R. F. Brooker, A. M. Nomeir, K. M. Fowle, P. Burgess, D. W. Kitzman

Research output: Contribution to journalArticle

Abstract

Background. A direct and accurate method of assessing aortic valve area (AVA) in patients with aortic stenosis (AS) is desirable because of the well- known theoretical and practical limitations of the currently available methods. We aassessed the clinical feasibility and accuracy of a novel index, the 3-dimensional surface area (3-DSA) of the aortic valve office by 3- dimensional transesophageal echocardiography (3-DTEE) in patients with AS. Methods. Intraoperative 3-DTEE was performed in 23 consecutive patients (mean age 58 ± 15 years) with valvular AS using a Toshiba SSA-380A system with a multiplane TEE probe and a TomTec EchoScan system. The 3-DTEE acquisition, processing and reconstruction were conducted and the aortic valve orifice presented using a 'surgeon's aortotomy view' (aortic valve orifice as if viewed through an open aortic root). The 3-D images were videotaped and calibrated and the 3-DSA measured by planimetry of the inner surface of the aortic valve leaflets at the maximal systolic opening using the dynamic 3D images. For comparison, the 2-D cross sectional area (2-DCSA) of the aortic valve was also determined by 2-DTEE. The 3DSA and 2-DCSA were compared with the AVA by the invasive Gorlin formula and the Doppler continuity equation method by transthoracic echocardiography. Results. The 3-DSA and 2-DCSA measurements were feasible in all but one patient. Both 3-DSA and 2-DCSA correlated moderately well with the AVA by the Gorlin formula (n = 17, r = 0.66, standard error of the estimate [SEE] = 0.3 cm2, P <.05 for 3-DSA and r = 0.61, SEE = 0.5 cm2, P <.05 for 2-DCSA, respectively). They also correlated well with the AVA by Doppler continuity equation method (n = 22, r = 0.90, SEE = 0.1 cm2, P <.05 for 3-DSA and r = 0.83, SEE = 0.3 cm2, P <.05 for 2-DCSA, respectively). There was no statistically significant difference between the 3-DSA and AVA by both the Gorlin formula (Δ = 0.1 ±. 0.3 cm2, P = .3) and the Doppler continuity equation (Δ = -0.0 ± 0.3 cm2, P = 7). In contrast, the 2. DCSA significantly overestimated AVA by the Gorlin formula (Δ = 0.5 ± 0.5 cm2, P <.005) and by the Doppler continuity equation (Δ = 0.5 ± 0.6 cm2, P <.0001). Conclusions. Planimetry of 3-DSA of the aortic valve orifice by 3-DTEE is a clinically feasible and relatively accurate technique for assessment of AVA and is superior to 2-DCSA by 2- DTEE.

Original languageEnglish (US)
Pages (from-to)1042-1050
Number of pages9
JournalAmerican Heart Journal
Volume136
Issue number6
DOIs
StatePublished - 1998
Externally publishedYes

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Three-Dimensional Echocardiography
Aortic Valve Stenosis
Aortic Valve
Transesophageal Echocardiography
Three-Dimensional Imaging
Echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Three-dimensional surface area of the aortic valve orifice by three- dimensional echocardiography : Clinical validation of a novel index for assessment of aortic stenosis. / Ge, S.; Warner J.G., Jr; Abraham, T. P.; Kon, N. D.; Brooker, R. F.; Nomeir, A. M.; Fowle, K. M.; Burgess, P.; Kitzman, D. W.

In: American Heart Journal, Vol. 136, No. 6, 1998, p. 1042-1050.

Research output: Contribution to journalArticle

Ge, S. ; Warner J.G., Jr ; Abraham, T. P. ; Kon, N. D. ; Brooker, R. F. ; Nomeir, A. M. ; Fowle, K. M. ; Burgess, P. ; Kitzman, D. W. / Three-dimensional surface area of the aortic valve orifice by three- dimensional echocardiography : Clinical validation of a novel index for assessment of aortic stenosis. In: American Heart Journal. 1998 ; Vol. 136, No. 6. pp. 1042-1050.
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title = "Three-dimensional surface area of the aortic valve orifice by three- dimensional echocardiography: Clinical validation of a novel index for assessment of aortic stenosis",
abstract = "Background. A direct and accurate method of assessing aortic valve area (AVA) in patients with aortic stenosis (AS) is desirable because of the well- known theoretical and practical limitations of the currently available methods. We aassessed the clinical feasibility and accuracy of a novel index, the 3-dimensional surface area (3-DSA) of the aortic valve office by 3- dimensional transesophageal echocardiography (3-DTEE) in patients with AS. Methods. Intraoperative 3-DTEE was performed in 23 consecutive patients (mean age 58 ± 15 years) with valvular AS using a Toshiba SSA-380A system with a multiplane TEE probe and a TomTec EchoScan system. The 3-DTEE acquisition, processing and reconstruction were conducted and the aortic valve orifice presented using a 'surgeon's aortotomy view' (aortic valve orifice as if viewed through an open aortic root). The 3-D images were videotaped and calibrated and the 3-DSA measured by planimetry of the inner surface of the aortic valve leaflets at the maximal systolic opening using the dynamic 3D images. For comparison, the 2-D cross sectional area (2-DCSA) of the aortic valve was also determined by 2-DTEE. The 3DSA and 2-DCSA were compared with the AVA by the invasive Gorlin formula and the Doppler continuity equation method by transthoracic echocardiography. Results. The 3-DSA and 2-DCSA measurements were feasible in all but one patient. Both 3-DSA and 2-DCSA correlated moderately well with the AVA by the Gorlin formula (n = 17, r = 0.66, standard error of the estimate [SEE] = 0.3 cm2, P <.05 for 3-DSA and r = 0.61, SEE = 0.5 cm2, P <.05 for 2-DCSA, respectively). They also correlated well with the AVA by Doppler continuity equation method (n = 22, r = 0.90, SEE = 0.1 cm2, P <.05 for 3-DSA and r = 0.83, SEE = 0.3 cm2, P <.05 for 2-DCSA, respectively). There was no statistically significant difference between the 3-DSA and AVA by both the Gorlin formula (Δ = 0.1 ±. 0.3 cm2, P = .3) and the Doppler continuity equation (Δ = -0.0 ± 0.3 cm2, P = 7). In contrast, the 2. DCSA significantly overestimated AVA by the Gorlin formula (Δ = 0.5 ± 0.5 cm2, P <.005) and by the Doppler continuity equation (Δ = 0.5 ± 0.6 cm2, P <.0001). Conclusions. Planimetry of 3-DSA of the aortic valve orifice by 3-DTEE is a clinically feasible and relatively accurate technique for assessment of AVA and is superior to 2-DCSA by 2- DTEE.",
author = "S. Ge and {Warner J.G.}, Jr and Abraham, {T. P.} and Kon, {N. D.} and Brooker, {R. F.} and Nomeir, {A. M.} and Fowle, {K. M.} and P. Burgess and Kitzman, {D. W.}",
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TY - JOUR

T1 - Three-dimensional surface area of the aortic valve orifice by three- dimensional echocardiography

T2 - Clinical validation of a novel index for assessment of aortic stenosis

AU - Ge, S.

AU - Warner J.G., Jr

AU - Abraham, T. P.

AU - Kon, N. D.

AU - Brooker, R. F.

AU - Nomeir, A. M.

AU - Fowle, K. M.

AU - Burgess, P.

AU - Kitzman, D. W.

PY - 1998

Y1 - 1998

N2 - Background. A direct and accurate method of assessing aortic valve area (AVA) in patients with aortic stenosis (AS) is desirable because of the well- known theoretical and practical limitations of the currently available methods. We aassessed the clinical feasibility and accuracy of a novel index, the 3-dimensional surface area (3-DSA) of the aortic valve office by 3- dimensional transesophageal echocardiography (3-DTEE) in patients with AS. Methods. Intraoperative 3-DTEE was performed in 23 consecutive patients (mean age 58 ± 15 years) with valvular AS using a Toshiba SSA-380A system with a multiplane TEE probe and a TomTec EchoScan system. The 3-DTEE acquisition, processing and reconstruction were conducted and the aortic valve orifice presented using a 'surgeon's aortotomy view' (aortic valve orifice as if viewed through an open aortic root). The 3-D images were videotaped and calibrated and the 3-DSA measured by planimetry of the inner surface of the aortic valve leaflets at the maximal systolic opening using the dynamic 3D images. For comparison, the 2-D cross sectional area (2-DCSA) of the aortic valve was also determined by 2-DTEE. The 3DSA and 2-DCSA were compared with the AVA by the invasive Gorlin formula and the Doppler continuity equation method by transthoracic echocardiography. Results. The 3-DSA and 2-DCSA measurements were feasible in all but one patient. Both 3-DSA and 2-DCSA correlated moderately well with the AVA by the Gorlin formula (n = 17, r = 0.66, standard error of the estimate [SEE] = 0.3 cm2, P <.05 for 3-DSA and r = 0.61, SEE = 0.5 cm2, P <.05 for 2-DCSA, respectively). They also correlated well with the AVA by Doppler continuity equation method (n = 22, r = 0.90, SEE = 0.1 cm2, P <.05 for 3-DSA and r = 0.83, SEE = 0.3 cm2, P <.05 for 2-DCSA, respectively). There was no statistically significant difference between the 3-DSA and AVA by both the Gorlin formula (Δ = 0.1 ±. 0.3 cm2, P = .3) and the Doppler continuity equation (Δ = -0.0 ± 0.3 cm2, P = 7). In contrast, the 2. DCSA significantly overestimated AVA by the Gorlin formula (Δ = 0.5 ± 0.5 cm2, P <.005) and by the Doppler continuity equation (Δ = 0.5 ± 0.6 cm2, P <.0001). Conclusions. Planimetry of 3-DSA of the aortic valve orifice by 3-DTEE is a clinically feasible and relatively accurate technique for assessment of AVA and is superior to 2-DCSA by 2- DTEE.

AB - Background. A direct and accurate method of assessing aortic valve area (AVA) in patients with aortic stenosis (AS) is desirable because of the well- known theoretical and practical limitations of the currently available methods. We aassessed the clinical feasibility and accuracy of a novel index, the 3-dimensional surface area (3-DSA) of the aortic valve office by 3- dimensional transesophageal echocardiography (3-DTEE) in patients with AS. Methods. Intraoperative 3-DTEE was performed in 23 consecutive patients (mean age 58 ± 15 years) with valvular AS using a Toshiba SSA-380A system with a multiplane TEE probe and a TomTec EchoScan system. The 3-DTEE acquisition, processing and reconstruction were conducted and the aortic valve orifice presented using a 'surgeon's aortotomy view' (aortic valve orifice as if viewed through an open aortic root). The 3-D images were videotaped and calibrated and the 3-DSA measured by planimetry of the inner surface of the aortic valve leaflets at the maximal systolic opening using the dynamic 3D images. For comparison, the 2-D cross sectional area (2-DCSA) of the aortic valve was also determined by 2-DTEE. The 3DSA and 2-DCSA were compared with the AVA by the invasive Gorlin formula and the Doppler continuity equation method by transthoracic echocardiography. Results. The 3-DSA and 2-DCSA measurements were feasible in all but one patient. Both 3-DSA and 2-DCSA correlated moderately well with the AVA by the Gorlin formula (n = 17, r = 0.66, standard error of the estimate [SEE] = 0.3 cm2, P <.05 for 3-DSA and r = 0.61, SEE = 0.5 cm2, P <.05 for 2-DCSA, respectively). They also correlated well with the AVA by Doppler continuity equation method (n = 22, r = 0.90, SEE = 0.1 cm2, P <.05 for 3-DSA and r = 0.83, SEE = 0.3 cm2, P <.05 for 2-DCSA, respectively). There was no statistically significant difference between the 3-DSA and AVA by both the Gorlin formula (Δ = 0.1 ±. 0.3 cm2, P = .3) and the Doppler continuity equation (Δ = -0.0 ± 0.3 cm2, P = 7). In contrast, the 2. DCSA significantly overestimated AVA by the Gorlin formula (Δ = 0.5 ± 0.5 cm2, P <.005) and by the Doppler continuity equation (Δ = 0.5 ± 0.6 cm2, P <.0001). Conclusions. Planimetry of 3-DSA of the aortic valve orifice by 3-DTEE is a clinically feasible and relatively accurate technique for assessment of AVA and is superior to 2-DCSA by 2- DTEE.

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