Assessment of left ventricular outflow tract and aortic root: comparison of 2D and 3D transthoracic echocardiography with multidetector computed tomography

2019 ◽  
Vol 20 (10) ◽  
pp. 1156-1163 ◽  
Author(s):  
Lasse Visby ◽  
Charlotte Burup Kristensen ◽  
Frederik Holm Grund Pedersen ◽  
Per Ejlstrup Sigvardsen ◽  
Klaus Fuglsang Kofoed ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Multidetector Computed Tomography ◽  
Aortic Root ◽  
Left Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Aortic Annulus ◽  
Left Ventricular Outflow ◽  
2D And 3D

Abstract Aims Accurate echocardiographic assessment of left ventricular outflow tract (LVOT) and the aortic root is necessary for risk stratification and choice of appropriate treatment in patients with pathologies of the aortic valve and aortic root. Conventional 2D transthoracic echocardiographic (TTE) assessment is based on the assumption of a circular shaped LVOT and aortic root, although previous studies have indicated a more ellipsoid shape. 3D TTE and multidetector computed tomography (MDCT) applies planimetry and are not dependent on geometrical assumptions. The aim was to test accuracy, feasibility, and reproducibility of 3D TTE compared to 2D TTE assessment of LVOT and aortic root areas, with MDCT as reference. Methods and results We examined 51 patients with 2D/3D TTE and MDCT at the same day. All patients were re-examined with 2D/3D TTE on a different day to evaluate 2D and 3D re-test variability. Areas of LVOT, aortic annulus, and sinus were assessed using 2D, 3D TTE, and MDCT. Both 2D/3D TTE underestimated the areas compared to MDCT; however, 3D TTE areas were significantly closer to MDCT-areas. 2D vs. 3D mean MDCT-differences: LVOT 1.61 vs. 1.15 cm2, P = 0.019; aortic annulus 1.96 vs. 1.06 cm2, P < 0.001; aortic sinus 1.66 vs. 1.08 cm2, P = 0.015. Feasibility was 3D 76–79% and 2D 88–90%. LVOT and aortic annulus areas by 3D TTE had lowest variabilities; intraobserver coefficient of variation (CV) 9%, re-test variation CV 18–20%. Conclusion Estimation of LVOT and aortic root areas using 3D TTE is feasible, more precise and more accurate than 2D TTE.

scholarly journals INDIRECT ULTRASOUND EVALUATION OF LEFT VENTRICULAR OUTFLOW TRACT DIAMETER IMPLICATIONS FOR HEART FAILURE AND AORTIC STENOSIS SEVERITY ASSESSMENT.

2020 ◽  
Author(s):  
Gabriele Pestelli ◽  
Andrea Fiorencis ◽  
Valeria Pergola ◽  
Giovanni Luisi ◽  
Vittorio Smarrazzo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Aortic Stenosis ◽  
Aortic Root ◽  
Left Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Regression Equation ◽  
Ultrasound Evaluation ◽  
Left Ventricular Outflow

Background. Whereas dependency of left ventricular outflow tract diameter (LVOTD) from body surface area (BSA) has been established and a BSA-based LVOTD formula has been derived, the relationship between LVOTD and aortic root and LV dimensions has never been explored. This may have implications for evaluation of LV output in heart failure (HF) and aortic stenosis (AS) severity. Methods. A cohort of 540 HF patients who underwent transthoracic echocardiography was divided in a derivation and validation subgroup. In the derivation subgroup (N=340) independent determinants of LVOTD were analyzed to derive a regression equation, which was used for predicting LVOTD in the validation subgroup (N=200) and compared with the BSA-derived formula. Results. LVOTD determinants in the derivation subgroup were sinuses of Valsalva diameter (SVD, beta=0.392, P<0.001), BSA (beta=0.229, P<0.001), LV end-diastolic diameter (LVEDD, beta=0.145, P=0.001), and height (beta=0.125, P=0.037). The regression equation for predicting LVOTD with the aforementioned variables (LVOTD=6.209+[0.201xSVD]+[1.802xBSA]+[0.03xLVEDD]+[0.025xHeight]) did not differ from (P=0.937) and was highly correlated with measured LVOTD (R=0.739, P<0.001) in the validation group. Repeated analysis with LV end-diastolic volume instead of LVEDD and/or accounting for gender showed similar results, whereas BSA-derived LVOTD values were different from measured LVOTD (P<0.001). Conclusion. Aortic root and LV dimensions affect LVOTD independently from anthropometric data and are included in a new comprehensive equation for predicting LVOTD. This should improve evaluation of LV output in HF and severity of AS, avoiding use of LVOT velocity-time integral alone, which can be misleading, especially when LV cavity and aortic root dimensions are abnormal.

scholarly journals Redo aortic root operations in late prosthetic endocarditis: clinical case series

2019 ◽  
Vol 23 (4) ◽  
pp. 73
Author(s):  
I. I. Skopin ◽  
P. V. Kakhktsyan ◽  
M. S. Latyshev ◽  
D. V. Murysova ◽  
T. A. Kupriy ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Conflict Of Interest ◽  
Aortic Root ◽  
Left Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Infectious Endocarditis ◽  
Infectious Focus ◽  
Left Ventricular Outflow

<p>Prosthetic aortic valve endocarditis is a severe disease that quickly leads to heart failure. Owing to microorganisms and their toxins constantly entering the bloodstream, bypassing biological barriers, and hemodynamic disturbances, systemic embolism develops quite quickly, leading to sepsis and multi-organ failure. Conservative antibiotic therapy is often not effective because the infectious focus is located in the avascular zone. The presence of an implanted foreign body promotes adhesion of bacteria on the surface of the prosthetic tissue with simultaneous isolation from the action of phagocytes. Conservative treatment of prosthetic infectious endocarditis has an extremely unfavourable prognosis. Hospital mortality without operation is approximately 80%. Operations for prosthetic infectious endocarditis of the aortic valve are technically complex and require a highly qualified operating surgeon. The most difficult operations involve extension of the abscess to the aortic root, area of mitralaortic continuity and left ventricular outflow tract. In such situations, it is necessary to perform complex reconstructive operations on the aortic root, mitral-aortic continuity and left ventricular outflow tract. This study presents an overview of a series of complex redo operations on the aortic root and the ascending aorta in late prosthetic infectious endocarditis, with an analysis of the main tactical and technical aspects of the operations. Moreover, similar operations can be performed with good results by an experienced cardiac surgeon. In this case, it is necessary that prior to operation, the surgeon develops an algorithm of actions and determines 1) optimal access to the heart, 2) perfusion scheme, 3) type of implantable conduit, 4) cardiolysis performance features, 5) myocardial protection scheme and 6) features of the treatment of the infectious focus.</p><p>Received 29 October 2019. Revised 19 December 2019. Accepted 23 December 2019.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Drafting the article: I.I. Skopin, P.V. Kakhktsyan, M.S. Latyshev, D.V. Murysova, T.A. Kupriy, I.A. Zhangeriev<br />Critical revision of the article: I.I. Skopin, P.V. Kakhktsyan, M.S. Latyshev, D.V. Murysova, T.A. Kupriy, I.A. Zhangeriev, E.V. Khasigova, L.Zh. Enokyan<br />Surgical treatment I.I. Skopin, P.V. Kakhktsyan<br />Diagnostics: L.Zh. Enokyan<br />Treatment: D.V. Murysova, T.A. Kupriy<br />Assistance in surgery: M.S. Latyshev, E.V. Khasigova<br />Final approval of the version to be published: I.I. Skopin, P.V. Kakhktsyan, M.S. Latyshev, D.V. Murysova, T.A. Kupriy, I.A. Zhangeriev, E.V. Khasigova, L.Zh. Enokyan</p>

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