Clin Res Cardiol 100, Suppl 1, April 2011

P1340 - Value Of 3d-echocardiography In Patient Selection Prior To Implantation Of A CoreValveĀ®-prosthesis
R. Schueler1, M. Weber1, D. Momcilovic1, A. Ghanem1, J.-M. Sinning1, N. Werner1, G. Nickenig1, C. Hammerstingl1
1Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Bonn;
Background: Transcatheter aortic valve replacement (TAVI) is established in patients at high risk for cardiovascular surgery. The benefit of the procedure is sometimes limited by relevant prosthesis mismatch. The optimal imaging-technique to evaluate aortic anatomy suitable for TAVI is not clear defined. The aims of this study were (a) to determine the value of 2D-transesophageal echocardiography (TOE) and (b) to analyze the benefits of 3D-TOE in preselecting TAVI-patients.
Methods and results: Between 2009-2010 86 patients (42male;age,81.2 ± 6.5 years; creatinine,1.6±1.2 mg/dl; aortic valve area, 0.64cm² ±0.1; log Euroscore 29.7 ±17.6, LV-EF49% ±16.7) were prospectively included. All patients underwent 2D-TOE and angiography to determine the diameters of (i) bulb of aorta (AoB), (ii) sinotubular junction (STJ), (iii) aortic valve (AoV), (iv) ascending aorta (AoAsc). In 40 patients 3D-TOE was performed with off-line reconstruction of the aortic anatomy.
For the determination of aortic diameters, 2D-TOE differed significantly compared to angiography (AoAsc: 27.6 ± 4.2 vs. 31.9 ± 4.6, p<0.001; AoB: 28.7 ± 4.4 vs. 35.4 ± 5.1, p<0.001; STJ: 23.5 ± 3.6 vs. 29.01 ± 4.1, p<0.001; AoV: 19.9 ± 2.8 vs. 25.4 ± 4.4, p<0.001). Off-line 3D-analysis differed significantly compared to conventional echocardiography echocardiography (AoAsc: 27.6 ± 4.1 vs. 28.8 ± 4.6, p=0.019, AoV: 20.3 ± 3.0 vs. 24.3 ± 2.6, p=0.0076, AoB: 28.8 ± 4.5 vs. 30.3 ± 3.0, p=0.034, STJ 23.6 ± 3.6 vs. 26.2 ± 3.1, p=0.0014). Only 3D-reconstruction of the aortic-root allowed evaluation of the alignment of the ascending aorta in relation to the plane of the aortic valve or left ventricular outflow tract  (alpha = 89.3°± 11.5°, beta= 83.2° ± 10.8°). Alpha < 70° and beta < 80° were associated with complications (e.g. atrioventricular block III, paravalvular insufficiency).
Conclusions: 3D-TOE offers significant advantages compared to standard 2D-techniques for the evaluation of aortic anatomy before TAVI:
1. High feasibility and angulation-independent determination of aortic-valve diameters.
2. Reliable reconstruction of the ascending aorta and aortic valve anatomy.
3. Quantification of the alignment of the ascending aorta in relation to the aortic valve and the left ventricular outflow tract.
Clin Res Cardiol 100, Suppl 1, April 2011
Zitierung mit Vortrags- oder Posternummer s.o.
DOI 10.1007/s00392-011-1100-y