Comparison of Multiplane and Biplane Transesophageal Echocardiography in the Assessment of Aortic Stenosis

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Abstract

The aim of the study was to compare the accuracy of multiplane transesophageal echocardiography (TEE) with the more conventional biplane technique in the direct assessment of aortic valve area in patients with aortic stenosis. Short-axis images of the aortic valve adequate for measuring aortic valve area were obtained in all 81 patients studied by multiplane TEE but in only 56 of 64 patients (88%) using the biplane approach. The correlation coefficient for aortic valve area determined by multiplane TEE (r = 0.89; SEE = 0.04 cm2) was higher (p <0.01) than biplane TEE (r = 0.74; SEE = 0.06 cm2). Correlations were higher for bicuspid valves (multiplane, r = 0.93; biplane, r = 0.75) than tricuspid valves (multiplane, r = 0.87; biplane, r = 0.75). Our study has demonstrated the superiority of multiplane TEE to both biplane TEE and transthoracic echocardiography (TTE) in the direct evaluation of aortic valve area in patients with aortic stenosis.

Our study has demonstrated the superiority of multiplane transesophageal echocardiography over both biplane transesophageal echocardiography and transthoracic echocardiography in the direct evaluation of aortic valve area in patients with aortic stenosis.

Section snippets

Methods

The study extended over a period of 18 months and included 145 patients. The study population included all patients with aortic stenosis who had transthoracic echocardiography, left and right heart catheterization, intraoperative TEE, and intraoperative evaluation of the aortic valve. However, 10 other patients with associated severe aortic regurgitation were excluded from the study because the aortic valve area cannot be reliably calculated at cardiac catheterization in the presence of severe

Results

During cardiac catheterization, pressure gradients across the aortic valve and aortic valve area by Gorlin equation were measured in 140 of 145 patients. They were not measured in 5 patients. There was no significant difference between aortic valve areas of bicuspid and tricuspid aortic stenosis.

With use of transthoracic echocardiography, the aortic valve area could be calculated in 138 of 145 patients studied. It was not available in 7 patients. Correlation between aortic valve area determined

Discussion

In the present study, multiplane TEE was found to be superior to biplane TEE in the assessment of aortic valve orifice when compared with cardiac catheterization (r = 0.89 for multiplane and 0.74 for biplane technique, p <0.01). Also, intra- and interobserver variability was very low. The multiplane transducer consistently allows for the aortic valve to be viewed in true short axis. This was most frequently found between plane angulations of 31° to 60°. As a result, the valve orifice could be

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