Two-Dimensional Transesophageal Echocardiography Assessment of the Major Aortic Annulus Diameter in Patients Undergoing Transcatheter Aortic Valve Replacement

Figure 1. Modified transesophageal echocardiography five-chamber view for the measurement of major aortic annular diameter. (a) From a standard mid-esophageal 0° four-chamber view (left), the probe is pulled up until the base of the left and noncoronary cusps is visualized (right), and the distance between the insertion points of the two cusps is measured at end-systole. (b) Three-dimensional transesophageal echocardiography reconstructions showing the anatomical premises of the approach; green panel (upper left) demonstrates the modified five-chamber view described above; red panel (upper right) represents an orthogonal-plane reconstruction showing correct alignment with the true major annulus diameter; a grid on the far right serves as geometrical model of the anatomy of the aortic annulus, valve, and root

Figure 2. Major diameters measured by multidetector computed tomography (left column) and two-dimensional transesophageal echocardiograph (right column); the three cases refer to patients with small (21 mm), intermediate (26 mm), and large (31 mm) CoreValve size selection

Figure 3. Correlation between two-dimensional transesophageal echocardiograph major diameter and multidetector computed tomography major diameter (Panel A) and final prosthesis size (Panel B)

Figure 4. Bland–Altman chart depicting agreement between multidetector computed tomography and two-dimensional transesophageal echocardiograph major annular diameters; solid line defines mean bias, dashed lines define upper and lower LOA (±1.96 standard deviation)

Figure 5. Prosthesis size prediction by two-dimensional transesophageal echocardiograph stratified by actual final prosthesis size