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, 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.
N1 - Funding Information:
Supported in part by North Carolina Baptist Hospital Developmental Technology Grant A-01-96/97R and the Center for Medical Ultrasound Research and Development Fund, Wake Forest University School of Medicine.
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.
UR - http://www.scopus.com/inward/record.url?scp=0032469140&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0032469140&partnerID=8YFLogxK
U2 - 10.1016/S0002-8703(98)70161-9
DO - 10.1016/S0002-8703(98)70161-9
M3 - Article
C2 - 9842018
AN - SCOPUS:0032469140
SN - 0002-8703
VL - 136
SP - 1042
EP - 1050
JO - American heart journal
JF - American heart journal
IS - 6
ER -