Accuracy and usefulness of aortic annular measurement using real-time three-dimensional transesophageal echocardiography: Comparison with direct surgical sizing

作者：Nishi Tomoko; Shibayama Kentaro^*; Tabata Minoru; Kato Nahoko; Noguchi Masahiko; Okumura Hiroshi; Kawano Yuji; Nakatsuka Daisuke; Obunai Kotaro; Kobayashi Yoshio; Watanabe Hiroyuki

来源：Journal of Cardiology, 2018, 71(3-4): 230-236.

DOI：10.1016/j.jjcc.2017.08.009

• Three-dimensional transesophageal echocardiography
• Valvular heart disease
• Aortic annular measurement
• Direct surgical sizing

Background: There is a paucity of data that demonstrates a clinical impact of anatomical measurements of the aortic annulus by three-dimensional (3D) transesophageal echocardiography (TEE) on surgical aortic valve replacement (AVR). The aim of this study is to validate the accuracy of 3D TEE measurements compared with the direct intraoperative annular diameter and to investigate an impact of 3D TEE on a prediction of AVR with aortic annular enlargement (AAE).
Methods and results: We retrospectively enrolled 61 patients who underwent both two-dimension (2D) and 3D TEE and transthoracic echocardiography (TTE) before AVR. The annular diameters were measured noninvasively with 2D TEE (D-2D) and TTE (D-TTE) in a classical manner and the area- and perimeter-derived annular diameters (D-area, D-perim) were measured from using 3D TEE analysis. Intraoperative annular diameter was measured with the manufacture's sizer showed the best agreement with D-intraope in the Bland Altman analysis. D-area, D-perim, D-2D, and D-TTE correlated well with D-intraope (r = 0.821, 0.820, 0.532, and 0.610, respectively; all p < 0.001). Three patients underwent AVR with AAE and the specificity of D-perim for prediction of AAE was significantly higher than D-2D (p = 0.008).
Conclusions: 3D TEE measurement of aortic annular diameter showed better agreement with the direct intraoperative measurement than 2D TEE and TTE measurements. 3D TEE measurement could predict AVR with AAE more accurately than 2D TEE and TTE measurements.

• 出版日期2018-4