Measuring aortic valve coaptation surface area using three-dimensional transesophageal echocardiography

Area of Science:

• Cardiovascular Imaging
• Echocardiography
• Cardiac Surgery

Background:

• Sophistication in aortic valve (AV) repair necessitates detailed structural and functional information.
• Three-dimensional transesophageal echocardiography (3D-TEE) allows comprehensive imaging of the entire AV, surpassing 2D-TEE limitations.
• Hypothesis: Measuring coaptation surface area (CoapSA) is feasible, reproducible, and decreases in patients with aortic insufficiency (AI).

Purpose of the Study:

• To introduce a novel technique for calculating AV-CoapSA using 3D-TEE.
• To assess the feasibility and reproducibility of CoapSA measurements.
• To determine if CoapSA differs between normal AVs and those with AI.

Main Methods:

• A new 3D-TEE technique was developed to compute AV-CoapSA.
• Coaptation surfaces were measured in 10 normal AVs and 10 with moderate-to-severe AI.
• CoapSA was calculated using a trapezoidal formula and indexed to the ventricular aortic junction (VAJ) diameter.

Main Results:

• High intra-observer (0.84-0.93) and inter-observer (0.87) correlations confirmed reproducibility (P < 0.0001).
• Normal AVs exhibited significantly greater CoapSA (1.61 cm²) than insufficient AVs (1.03 cm²; P < 0.001).
• Indexed CoapSA remained significantly higher in normal valves compared to insufficient valves.

Conclusions:

• A novel, reproducible 3D-TEE technique for measuring AV-CoapSA is presented.
• Decreased CoapSA was observed in patients with AI, suggesting potential insights into AI mechanisms.
• CoapSA may hold predictive value for outcomes following aortic valve repair.