Comparison of Aortic Annulus Size by Transesophageal Echocardiography and Computed Tomography Angiography With Direct Surgical Measurement
Comparison of Aortic Annulus Size by Transesophageal Echocardiography and Computed Tomography Angiography With Direct Surgical Measurement
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DOI：
10.1016/j.amjcard.2015.02.060
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发表时间：
2015-06-01
影响因子：
2.8
通讯作者：
Hughes, G. Chad
中科院分区：
文献类型：
--
作者：
Wang, Hanghang;Hanna, Jennifer M.;Hughes, G. Chad
本研究旨在比较二维经食道超声心动图(TEE)和CT血管成像(CTA)对经导管主动脉瓣置入术(TAVI)所需的无创性主动脉环大小的准确性。术中直接测量(OR)是外科主动脉瓣置换术中测量主动脉环的金标准。与外科主动脉瓣置换术不同，TAVI需要对主动脉环大小进行无创性评估，以确定要植入的假体的大小，对于TAVI大小的最佳成像技术存在争议。我们回顾了在杜克大学医学中心接受主动脉近端手术的227例患者的主动脉环术前CTA和OR TEE图像。将这两种成像技术与直接或间接测量主动脉环直径进行比较，并以公制尺度计作为金标准。CTA高估了72.2%的患者的主动脉环直径，其中46.3%高估了TAVI瓣膜大小(3 Mm)，而TEE低估了51.1%的患者的主动脉环直径，16.7%的患者低估了瓣膜大小。这两种技术的结合提高了对主动脉环大小的估计。综上所述，与直接OR测量相比，目前用于无创性确定主动脉环大小的成像技术存在局限性。TEE的尺寸不足和CTA的尺寸过大很常见，这可能与椭圆形结构尺寸调整的方法不同有关。结合这两种技术的测量结果将降低由于尺寸不匹配而导致的TAVI资格的假排斥率。(C)2015 Elsevier Inc.保留所有权利。
This study sought to compare the accuracy of 2-dimensional transesophageal echocardiography (TEE) and computed tomography angiography (CTA) for noninvasive aortic annular sizing as required for transcatheter aortic valve implantation (TAVI). Direct intraoperative (OR) sizing is the gold standard for aortic annular measurement in surgical aortic valve replacement. Unlike surgical aortic valve replacement, TAVI requires noninvasive assessment of aortic annular dimensions for determining the size of prosthesis to be implanted and controversy exists regarding the best imaging technique for TAVI sizing. Preoperative CTA and OR TEE images of the aortic annulus in 227 patients who underwent proximal aortic surgery with OR annular sizing at the Duke University Medical Center were reviewed. Both imaging techniques were compared with direct OR measurements of aortic annulus diameter using metric sizers as the gold standard. CTA overestimated aortic annulus diameter in 72.2% of cases, with 46.3% >1 TAVI valve-size (>3 mm) overestimations, whereas TEE underestimated aortic annulus diameter in 51.1% of cases, with 16.7% >1 valve-size underestimations. Combining both techniques improved the estimation of aortic annular size. In conclusion, there are limitations to current imaging techniques for noninvasive determination of aortic annular dimensions compared with direct OR sizing. Undersizing by TEE and oversizing by CTA are common and may be related to differences in methods for sizing an elliptical structure. Combining measurements from both techniques would decrease the false exclusion rate for TAVI eligibility because of size mismatch. (C) 2015 Elsevier Inc. All rights reserved.