TY - JOUR
T1 - Planimetric assessment of anatomic valve area overestimates effective orifice area in bicuspid aortic stenosis
AU - Donal, Erwan
AU - Novaro, Gian M.
AU - Deserrano, Dimitri
AU - Popovic, Zoran B.
AU - Greenberg, Neil L.
AU - Richards, Kathryn E.
AU - Thomas, James D.
AU - Garcia, Mario J.
N1 - Funding Information:
Supported by a grant from the Federation Française de Cardiologie (Dr Donal).
PY - 2005/12
Y1 - 2005/12
N2 - Background: Although the continuity equation remains the noninvasive standard, planimetry using transesophageal echocardiography is often used to assess valve area for patients with aortic stenosis (AS). Not uncommonly, however, anatomic valve area (AVAA) obtained by planimetry overestimates continuity-derived effective valve area (AVAE) in bicuspid AS. Methods: Transthoracic Doppler and transesophageal echocardiography were performed to obtain AVAE and AVAA in 31 patients with bicuspid AS (age 61 ± 11 years) and 22 patients with degenerative tricuspid AS (age 71 ± 13 years). Aortic root and left ventricular outflow tract dimensions and the directional angle of the stenotic jet were assessed in all patients. Using these data, a computational fluid dynamics model was constructed to test the effect of these variables in determining the relationship between AVAE and AVAA. Results: For patients with tricuspid AS, the correlation between AVAA (1.15 ± 0.36 cm2) and AVAE (1.13 ± 0.46 cm2) was excellent (r = 0.91, P < .001, Δ = 0.02 ± 0.21 cm2). However, AVAA was significantly larger (1.19 ± 0.35 cm 2) than AVAE (0.89 ± 0.29 cm2) in the bicuspid AS group (r = 0.71, P < .001, Δ = 0.29 ± 0.25 cm 2). Computer simulation demonstrated that the observed discrepancy related to jet eccentricity. Conclusion: For a given anatomic orifice, functional severity tends to be greater in bicuspid AS than in tricuspid AS. This appears to be primarily related to greater jet eccentricity and less pressure recovery.
AB - Background: Although the continuity equation remains the noninvasive standard, planimetry using transesophageal echocardiography is often used to assess valve area for patients with aortic stenosis (AS). Not uncommonly, however, anatomic valve area (AVAA) obtained by planimetry overestimates continuity-derived effective valve area (AVAE) in bicuspid AS. Methods: Transthoracic Doppler and transesophageal echocardiography were performed to obtain AVAE and AVAA in 31 patients with bicuspid AS (age 61 ± 11 years) and 22 patients with degenerative tricuspid AS (age 71 ± 13 years). Aortic root and left ventricular outflow tract dimensions and the directional angle of the stenotic jet were assessed in all patients. Using these data, a computational fluid dynamics model was constructed to test the effect of these variables in determining the relationship between AVAE and AVAA. Results: For patients with tricuspid AS, the correlation between AVAA (1.15 ± 0.36 cm2) and AVAE (1.13 ± 0.46 cm2) was excellent (r = 0.91, P < .001, Δ = 0.02 ± 0.21 cm2). However, AVAA was significantly larger (1.19 ± 0.35 cm 2) than AVAE (0.89 ± 0.29 cm2) in the bicuspid AS group (r = 0.71, P < .001, Δ = 0.29 ± 0.25 cm 2). Computer simulation demonstrated that the observed discrepancy related to jet eccentricity. Conclusion: For a given anatomic orifice, functional severity tends to be greater in bicuspid AS than in tricuspid AS. This appears to be primarily related to greater jet eccentricity and less pressure recovery.
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U2 - 10.1016/j.echo.2005.04.005
DO - 10.1016/j.echo.2005.04.005
M3 - Article
C2 - 16376772
AN - SCOPUS:29244457214
SN - 0894-7317
VL - 18
SP - 1392
EP - 1398
JO - Journal of the American Society of Echocardiography
JF - Journal of the American Society of Echocardiography
IS - 12
ER -