Three-Dimensional Transesophageal Echocardiography Is Useful for Preventing Prosthetic-Patient Mismatch After Surgical Aortic Valve Replacement

Figures

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  Figure 1. Methods of three-dimensional analysis of aortic valve using transesophageal echocardiography. From preoperative three-dimensional transesophageal echocardiographic (3D TEE) data, aortic annulus area was measured using 3DQ software at mid-diastolic phase (A). Two-dimensional (2D) long-axis view: aortic annulus short diameter (red line) (B) and long diameter view (blue line) (C). 2D short-axis view (D), AV annulus area (yellow circle). AV; aortic valve.

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  Figure 2. Representative case of severe postoperative prosthesis-patient mismatch (PPM). The patient was a 68-year-old female with aortic stenosis. The aortic valve (AV) annulus area was 442 mm2 (yellow circle) and the AV annulus area-derived diameter was calculated as 23.2 mm. This patient was implanted with a 21-mm prosthetic valve, which was smaller than the recommended prosthesis AV size. AV annulus diameter was reduced by 9.5% after the procedure and severe PPM occurred. TEE; transesophageal echocardiography, AV; aortic valve, TTE; transthoracic echocardiography, V; velocity, PG; pressure gradient, EOAi; effective orifice area index.

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  Figure 3. Correlation between effective orifice area index and aortic valve annulus area parameters. Significant correlations were seen between effective orifice area index (EOAi) and aortic valve (AV) annulus diameter change ratio pre- and post-surgical aortic valve replacement (SAVR) (r = −0.24, p = 0.0004).