Novel three-dimensional transoesophageal echocardiography platform allows a fast and accurate assessment of aortic annulus size and shape before transcatheter aortic valve implantation

Background: In TAVI procedures, accurate sizing of aortic annulus (AA) is paramount to avoid complications. Novel 3D transoesophageal echo (3DTOE) platform enables direct measurements on volume-rendered 3D datasets, speeding up AA sizing in the cath lab. Our aim was to validate AA measurements by novel 3DTOE against computerized tomography (CT). Methods: Minimum (Min) and maximum (Max) AA diameters, and their ratio (ellipticity index, EI) were obtained in 12 consecutive patients (9 men, aged 84 ± 4 y) who underwent pre-TAVI 2D and 3DTOE (Vivid E9 with 6VT-D probe, GE Ultrasound, N) and CT scan less than 1 week apart. Results: AA sizing required 58 ± 20 sec on 3D volume-rendered datasets and 95 ± 17 sec on multislice (MS) views (p < 0.003) (Figure). At CT, Max was 25.4 ± 2 mm, Min was 21.6 ± 2.1 mm, and EI was 1.2 ± 0.07. Accuracy of 3DTOE is reported in Table. Conventional 2D antero-posterior diameters underestimated Max in comparison to both 3D volume-rendered and MS (bias=-2.8 mm and -2.9 mm, respectively). Conclusions: AA sizing can be performed in a fast and reliable way using novel 3DTOE. Direct measurement on 3D volume-rendered seems as accurate as measuring on MS views, but significantly less time-consuming.