Related Experiment Video
Updated: Jun 12, 2026
06:59
Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation
Published on: June 3, 2018
Aortic annulus evaluation in transcatheter aortic valve implantation
Andrea Hutter1, Anke Opitz, Sabine Bleiziffer
1Clinic for Cardiovascular Surgery, German Heart Centre Munich, Munich, Germany. huttera@dhm.mhn.de
Summary
Accurate aortic annulus measurement is crucial for transcatheter aortic valve implantation (TAVI). While transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and dual-source computed tomography (DSCT) correlate, TEE offers better reliability and impacts TAVI strategy safely.
Area of Science:
- Cardiology
- Medical Imaging
- Interventional Cardiology
Background:
- Accurate aortic annulus assessment is critical for successful transcatheter aortic valve implantation (TAVI).
- Choosing the correct prosthesis size and preventing complications depend on precise annulus measurements.
- Currently, no definitive gold standard exists for aortic annulus diameter assessment.
Purpose of the Study:
- To compare aortic annulus diameter measurements obtained by transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and dual-source computed tomography (DSCT) prior to TAVI.
- To evaluate the correlation and variability among these imaging modalities.
- To assess the impact of using TEE measurements as the primary determinant for TAVI strategy.
Main Methods:
- Preoperative assessment of the aortic annulus using TTE, TEE, and DSCT in 187 consecutive patients undergoing TAVI.
- Statistical analysis of measurements, including correlation and inter-/intraobserver variability.
- Evaluation of changes in implantation strategy and procedural complication rates based on TEE measurements.
Main Results:
- Mean annulus diameters were similar across DSCT (22.6 ± 2.0 mm), TTE (22.3 ± 2.5 mm), and TEE (22.9 ± 2.2 mm).
- Significant statistical spread (up to 3 mm) was observed between measurement techniques despite strong correlations.
- TEE demonstrated superior inter- and intraobserver variability compared to DSCT.
Conclusions:
- Despite strong correlations, significant statistical spread exists among TTE, TEE, and DSCT annulus measurements, limiting predictive accuracy.
- Transesophageal echocardiography (TEE) offers more reliable and reproducible measurements than dual-source computed tomography (DSCT).
- Utilizing TEE measurements as the decisive factor for TAVI implantation impacts strategy in 15.5% of cases but is safe, with no increase in procedural complications.
Related Concept Videos
01:22Aortic Regurgitation II: Clinical Features and Diagnostic Tests
Aortic valve regurgitation (AR) occurs when the aortic valve fails to close properly, allowing blood to flow backward from the aorta into the left ventricle. This backflow can result in two distinct clinical presentations: acute and chronic AR, each characterized by its own set of symptoms and physical findings.Acute Aortic RegurgitationAcute AR presents with a sudden onset of severe symptoms. Patients typically experience profound dyspnea (shortness of breath), chest pain, and signs of left...
01:15Aortic Regurgitation I: Introduction
IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...
01:17Aortic Regurgitation IV: Nursing Management
A nurse managing a patient with aortic regurgitation begins with a comprehensive assessment, including a review of the patient's medical history, family history, and lifestyle factors. During the cardiac examination, the nurse listens for heart sounds and checks for signs of valve abnormalities. The nurse also observes for symptoms such as dyspnea, orthopnea, and paroxysmal nocturnal dyspnea and assesses the patient's endurance and daily activity tolerance.Based on the findings, the nurse...
01:21Aneurysm II: Clinical Manifestations and Diagnostic Studies
Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
01:25Aortic Regurgitation III: Medical Management
Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
01:22Mitral Valve Prolapse II: Assessment and Management
IntroductionA range of clinical features characterizes Mitral Valve Prolapse (MVP), but it is important to note that many individuals with MVP are asymptomatic and may remain so throughout their lives. For those who do exhibit symptoms, the following are the key clinical features:Palpitations: This is a common symptom where individuals feel an irregular or rapid heartbeat. Palpitations in MVP are often due to arrhythmias such as premature ventricular contractions or supraventricular tachycardia.