Assessment of aortic valve complex by three-dimensional echocardiography: a framework for its effective application in clinical practice.

In the current era of expanding catheter-based and complex repair procedures to treat aortic valve (AV) diseases, growing consideration is being given to understanding the functional anatomy of the AV complex. Echocardiography is the primary imaging modality to assess and follow-up AV diseases, and the recent three-dimensional (3D) capabilities allow clinicians to appreciate the functional complexity of the aortic root in the beating heart. Despite being subject to several limitations, 3D echocardiography (3DE) holds promise as a more suitable imaging backup for aortic interventions of mounting complexity and for circumventing some of their current complications. In this review, we discuss the key principles of 3DE for assessing the AV pathology and the incremental clinical benefits in comparison with conventional 2DE and Doppler echocardiography, justifying its implementation in the diagnostic workup of aortic diseases. In view of an effective clinical use, a brief section is dedicated to the acquisition modalities, display, and interpretation of various abnormalities by 3DE.

[1]  A. C. Durán,et al.  Bicuspid aortic valves with different spatial orientations of the leaflets are distinct etiological entities. , 2009, Journal of the American College of Cardiology.

[2]  T Irvine,et al.  Three-dimensional reconstruction of the color Doppler-imaged vena contracta for quantifying aortic regurgitation: studies in a chronic animal model. , 1999, Circulation.

[3]  V. Jeevanandam,et al.  Real-time three-dimensional transesophageal echocardiography in valve disease: comparison with surgical findings and evaluation of prosthetic valves. , 2008, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[4]  Otto Kamp,et al.  EAE/ASE recommendations for image acquisition and display using three-dimensional echocardiography. , 2012, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[5]  R. Schnabel,et al.  Direct measurement of left ventricular outflow tract by transthoracic real-time 3D-echocardiography increases accuracy in assessment of aortic valve stenosis. , 2009, International journal of cardiology.

[6]  Ashraf Hamdan,et al.  Deformation dynamics and mechanical properties of the aortic annulus by 4-dimensional computed tomography: insights into the functional anatomy of the aortic valve complex and implications for transcatheter aortic valve therapy. , 2012, Journal of the American College of Cardiology.

[7]  Robert A Levine,et al.  Effect of three-dimensional valve shape on the hemodynamics of aortic stenosis: three-dimensional echocardiographic stereolithography and patient studies. , 2002, Journal of the American College of Cardiology.

[8]  J. Rodés‐Cabau,et al.  First‐in‐man transcatheter aortic valve implantation of a 20‐mm edwards SAPIEN XT valve: One step forward for the treatment of patients with severe aortic stenosis and small aortic annulus , 2012, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[9]  Chih‐Hui Chin,et al.  The Correlation between Three‐Dimensional Vena Contracta Area and Aortic Regurgitation Index in Patients with Aortic Regurgitation , 2010, Echocardiography.

[10]  J. Gnanapragasam,et al.  Correlations with operative anatomy of real time three-dimensional echocardiographic imaging of congenital aortic valvar stenosis , 2006, Cardiology in the Young.

[11]  J. Zamorano,et al.  3D color-Doppler echocardiography and chronic aortic regurgitation: a novel approach for severity assessment. , 2013, International journal of cardiology.

[12]  Robert H. Anderson,et al.  The surgical anatomy of the aortic root. , 2007, Multimedia manual of cardiothoracic surgery : MMCTS.

[13]  Robert J Ostfeld,et al.  Demonstration of Left Ventricular Outflow Tract Eccentricity by Real Time 3D Echocardiography: Implications for the Determination of Aortic Valve Area , 2007, Echocardiography.

[14]  B. Carabello,et al.  Valvular heart disease. , 1997, The New England journal of medicine.

[15]  L. Weinert,et al.  Valvular heart disease. The value of 3-dimensional echocardiography. , 2011, Journal of the American College of Cardiology.

[16]  Juan Luis Gutiérrez-Chico,et al.  Real-time three-dimensional echocardiography in aortic stenosis: a novel, simple, and reliable method to improve accuracy in area calculation. , 2008, European heart journal.

[17]  R. Suri Assessing aortic valve area in aortic stenosis by continuity equation: a novel approach using real-time three-dimensional echocardiography , 2009 .

[18]  N. Nanda,et al.  Assessment of Aortic Regurgitation by Live Three‐Dimensional Transthoracic Echocardiographic Measurements of Vena Contracta Area: Usefulness and Validation , 2005, Echocardiography.

[19]  Hiromi Nakai,et al.  Pitfalls of anatomical aortic valve area measurements using two-dimensional transoesophageal echocardiography and the potential of three-dimensional transoesophageal echocardiography. , 2010, European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology.

[20]  T. Abraham,et al.  Three-dimensional surface area of the aortic valve orifice by three-dimensional echocardiography: clinical validation of a novel index for assessment of aortic stenosis. , 1998, American heart journal.

[21]  G. Stetten,et al.  Quantification of aortic regurgitation by real-time 3-dimensional echocardiography in a chronic animal model: computation of aortic regurgitant volume as the difference between left and right ventricular stroke volumes. , 2001, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[22]  S. Siu,et al.  Bicuspid aortic valve disease. , 2010, Journal of the American College of Cardiology.

[23]  L. Cohn,et al.  Cardiac Surgery in the Adult , 2003 .

[24]  Reidar Winter,et al.  Direct Measurement of Left Ventricular Outflow Tract Area Using Three‐Dimensional Echocardiography in Biplane Mode Improves Accuracy of Stroke Volume Assessment , 2010, Echocardiography.

[25]  C. Bode,et al.  Transesophageal real-time three-dimensional echocardiography methods and initial in vitro and human in vivo studies. , 2006, Journal of the American College of Cardiology.

[26]  N. Espinola-Zavaleta,et al.  Anatomic three-dimensional echocardiographic correlation of bicuspid aortic valve. , 2003, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[27]  Robert H. Anderson,et al.  Anatomy of the Aortic Valvar Complex and Its Implications for Transcatheter Implantation of the Aortic Valve , 2008, Circulation. Cardiovascular interventions.

[28]  Philippe Pibarot,et al.  Usefulness of TEE as the primary imaging technique to guide transcatheter transapical aortic valve implantation. , 2011, JACC. Cardiovascular imaging.

[29]  Michael Becker,et al.  Comparison of two-dimensional and three-dimensional imaging techniques for measurement of aortic annulus diameters before transcatheter aortic valve implantation , 2011, Heart.

[30]  Harvey Feigenbaum,et al.  Feasibility of Using Real Time “Live 3D” Echocardiography to Visualize the Stenotic Aortic Valve , 2010, Echocardiography.

[31]  P. D. del Nido,et al.  Usefulness of intra-operative epicardial three-dimensional echocardiography to guide aortic valve repair in children. , 2009, The American journal of cardiology.

[32]  Kiyoshi Iida,et al.  Assessment of aortic stenosis by three-dimensional echocardiography: an accurate and novel approach , 2007, Heart.

[33]  C. Lamberti,et al.  A Study of Functional Anatomy of Aortic-Mitral Valve Coupling Using 3D Matrix Transesophageal Echocardiography , 2009, Circulation. Cardiovascular imaging.

[34]  L. Sugeng,et al.  Assessment of the aortic root using real-time 3D transesophageal echocardiography. , 2010, Circulation journal : official journal of the Japanese Circulation Society.

[35]  F. Robicsek,et al.  Leonardo da Vinci and the sinuses of Valsalva. , 1991, The Annals of thoracic surgery.

[36]  T. Marwick,et al.  Reproducibility and accuracy of echocardiographic measurements of left ventricular parameters using real-time three-dimensional echocardiography. , 2004, Journal of the American College of Cardiology.

[37]  J. Chambers,et al.  Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. , 2009, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[38]  Siew Yen Ho,et al.  Structure and anatomy of the aortic root. , 2009, European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology.

[39]  N. Espinola-Zavaleta,et al.  Aortic obstruction: anatomy and echocardiography , 2006, Cardiovascular ultrasound.

[40]  Jeroen J. Bax,et al.  Comparison of Aortic Root Dimensions and Geometries Before and After Transcatheter Aortic Valve Implantation by 2- and 3-Dimensional Transesophageal Echocardiography and Multislice Computed Tomography , 2010, Circulation. Cardiovascular imaging.

[41]  O. V. von Ramm,et al.  Real-time 3-dimensional echocardiography for quantification of the difference in left ventricular versus right ventricular stroke volume in a chronic animal model study: Improved results using C-scans for quantifying aortic regurgitation. , 2004, Journal of the American Society of Echocardiography.

[42]  F. Mauri,et al.  VALVULAR AND STRUCTURAL HEART DISEASES Original Studies Influence of CoreValve ReValving System Implantation on Mitral Valve Function: An Echocardiographic Study in Selected Patients , 2011 .

[43]  James D. Thomas,et al.  3D echocardiography: a review of the current status and future directions. , 2007, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[44]  S. P. Nolan,et al.  The dynamic aortic root. Its role in aortic valve function. , 1976, The Journal of thoracic and cardiovascular surgery.

[45]  M Jones,et al.  Direct measurement of three-dimensionally reconstructed flow convergence surface area and regurgitant flow in aortic regurgitation: in vitro and chronic animal model studies. , 1997, Circulation.