Objectives
The Doppler profile that quantifies the degree of aortic stenosis is essential, as
an inaccurate measurement can alter the surgical plan. The authors aimed to examine
the level of agreement between the contrast and noncontrast methods of aortic valve
sizing during intraoperative transesophageal echocardiography (TEE).
Setting
At a tertiary hospital.
Participants
A total of 30 patients undergoing surgical aortic valve replacement for a stenotic
valve.
Interventions
Perflutren lipid microsphere contrast injection.
Measurements and Main Results
The authors reviewed Doppler studies of 30 consecutive patients undergoing aortic
valve replacement in whom a contrast agent was given (perflutren lipid microsphere).
They measured the peak and/or mean aortic valve gradients and velocity time integral
readings through the left ventricular outflow tract (LVOT), and the aortic valve before
and after administering the contrast agent. The aortic valve area was then calculated
using both methods. Paired t tests and Bland-Altman analyses were used to examine the bias and the level of agreement
between the 2 processes. By not using a contrast agent, the aortic valve area was
overestimated by 0.26 cm2 compared to those measured by transthoracic echocardiography (TTE) (p < 0.001). Using
a contrast agent, TEE measurements were comparable to those obtained by TTE. Moreover,
the peak and mean aortic valve gradients were underestimated by 19 and 11 mmHg, respectively
(p value <0.001). Adding contrast did not affect the pulse-wave Doppler readings of
the V1 velocity of the LVOT.
Conclusion
This discrepancy is significant and could affect the decision to replace the aortic
valve. When evaluating the aortic valve with TEE, the authors recommend using a contrast
agent to improve the Doppler profile and to obtain a more accurate measurement of
the aortic valve area.
Key Words
Abbreviations:
TTE (Transthoracic Echocardiography), TEE (Transesophageal Echocardiography), AS (Aortic Stenosis), AVA (Aortic Valve Gradient), MGA (Mean aortic pressure gradient), PGA (Peak aortic valve pressure gradient)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 21, 2023
Publication stage
In Press Corrected ProofIdentification
Copyright
Published by Elsevier Inc.
