Validation of methods for effective orifice area measurement of prosthetic valves by two-dimensional and Doppler echocardiography following transcatheter self-expanding aortic valve implantation

Ming-Hu Xiao; Yong-Jian Wu; Jing-Jin Wang; Guang-Yuan Song; Jian-De Wang; Zhen-Hui Zhu; Xu Wang; Zhen-Yan Zhao; Hao Wang

doi:10.11909/j.issn.1671-5411.2020.12.006

Validation of methods for effective orifice area measurement of prosthetic valves by two-dimensional and Doppler echocardiography following transcatheter self-expanding aortic valve implantation

J Geriatr Cardiol. 2020 Dec 28;17(12):766-774. doi: 10.11909/j.issn.1671-5411.2020.12.006.

Authors

Ming-Hu Xiao¹, Yong-Jian Wu², Jing-Jin Wang¹, Guang-Yuan Song², Jian-De Wang¹, Zhen-Hui Zhu¹, Xu Wang³, Zhen-Yan Zhao², Hao Wang¹

Affiliations

¹ Department of Echocardiography, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
² Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
³ Department of Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

PMID: 33424944
PMCID: PMC7762695
DOI: 10.11909/j.issn.1671-5411.2020.12.006

Abstract

Background: The effective orifice area (EOA) is utilized to characterize the hemodynamic performance of the transcatheter heart valve (THV). However, there is no consensus on EOA measurement of self-expanding THV. We aimed to compare two echocardiographic methods for EOA measurement following transcatheter self-expanding aortic valve implantation.

Methods: EOA was calculated according to the continuity equation. Two methods were constructed. In Method 1 and Method 2, the left ventricular outflow tract diameter (LVOTd) was measured at the entry of the prosthesis (from trailing-to-leading edge) and proximal to the prosthetic valve leaflets (from trailing-to- leading edge), respectively. The velocity-time integral (VTI) of the LVOT (VTI_LVOT) was recorded by pulsed-wave Doppler (PW) from apical windows. The region of the PW sampling should match that of the LVOTd measurement with precise localization. The mean transvalvular pressure gradient (MG) and VTI of THV was measured by Continuous wave Doppler.

Results: A total of 113 consecutive patients were recruited. The mean age was 77.2 ± 5.5 years, and 72 patients (63.7%) were male. EOA₁ with the use of Method 1 was larger than EOA₂ (1.56 ± 0.39 cm² vs. 1.48 ± 0.41 cm², P = 0.001). MG correlated better with the indexed EOA₁ (EOAI₁) (r = -0.701, P < 0.001) than EOAI₂ (r = -0.645, P < 0.001). According to EOAI (EOAI ≤ 0.65 cm²/m², respectively), the proportion of sever prosthesis-patient mismatch with the use of EOA₁ was lower than EOA₂ (12.4% vs. 21.2%, P < 0.05). Compared with EOA₂, EOA₁ had lower interobserver and intra-observer variability (intra: 0.5% ± 17% vs. 3.8% ± 22%, P < 0.001; inter: 1.0% ± 9% vs. 3.5% ± 11%, P < 0.001).

Conclusions: For transcatheter self-expanding valve EOA measurement, LVOTd should be measured in the entry of the prosthesis stent (from trailing-to-leading edge), and VTI_LVOT should match that of the LVOTd measurement with precise localization.

Keywords: Aortic valve stenosis; Echocardiography; Transcatheter aortic valve implantation.

Copyright and License information: Journal of Geriatric Cardiology 2020.