• Hasan Jilaihawi, Niraj Doctor, Mohammad Kashif, Tarun Chakravarty, Asim Rafique, Moody Makar, Azusa Furugen, Mamoo Nakamura, James Mirocha, Mitch Gheorghiu, Jasminka Stegic, Kazuaki Okuyama, Daniel J Sullivan, Robert Siegel, James K Min, Swaminatha V Gurudevan, Gregory P Fontana, Wen Cheng, Gerald Friede, Takahiro Shiota, and Raj R Makkar.
• Cedars-Sinai Heart Institute, Los Angeles, CA 90048, USA.
• J. Am. Coll. Cardiol. 2013 Mar 5; 61 (9): 908-16.

ObjectivesThis study compared cross-sectional three-dimensional (3D) transesophageal echocardiography (TEE) to two-dimensional (2D) TEE as methods for predicting aortic regurgitation after transcatheter aortic valve replacement (TAVR).BackgroundData have shown that TAVR sizing using cross-sectional contrast computed tomography (CT) parameters is superior to 2D-TEE for the prediction of paravalvular aortic regurgitation (AR). Three-dimensional TEE can offer cross-sectional assessment of the aortic annulus but its role for TAVR sizing has been poorly elucidated.MethodsAll patients had severe symptomatic aortic stenosis and were treated with balloon-expandable TAVR in a single center. Patients studied had both 2D-TEE and 3D imaging (contrast CT and/or 3D-TEE) of the aortic annulus at baseline. Receiver-operating characteristic curves were generated for each measurement parameter using post-TAVR paravalvular AR moderate or greater as the state variable.ResultsFor the 256 patients studied, paravalvular AR moderate or greater occurred in 26 of 256 (10.2%) of patients. Prospectively recorded 2D-TEE measurements had a low discriminatory value (area under the curve = 0.52, 95% confidence interval: 0.40 to 0.63, p = 0.75). Average cross-sectional diameter by CT offered a high degree of discrimination (area under the curve = 0.82, 95% confidence interval: 0.73 to 0.90, p < 0.0001) and mean cross-sectional diameter by 3D-TEE was of intermediate value (area under the curve = 0.68, 95% confidence interval: 0.54 to 0.81, p = 0.036).ConclusionsCross-sectional 3D echocardiographic sizing of the aortic annulus dimension offers discrimination of post-TAVR paravalvular AR that is significantly superior to that of 2D-TEE. Cross-sectional data should be sought from 3D-TEE if good CT data are unavailable for TAVR sizing.Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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