Quantitative three-dimensional echocardiographic analysis of the bicuspid aortic valve and aortic root:A single modality approach

Background Patients with bicuspid aortic valves (BAV) are heterogeneous with regard to patterns of root remodeling and valvular dysfunction. Two-dimensional echocardiography is the standard surveillance modality for patients with aortic valve dysfunction. However, ancillary computed tomography or magnetic resonance imaging is often necessary to characterize associated patterns of aortic root pathology. Conversely, the pairing of three-dimensional (3D) echocardiography with novel quantitative modeling techniques allows for a single modality description of the entire root complex. We sought to determine 3D aortic valve and root geometry with this quantitative approach. Methods Transesophageal real-time 3D echocardiography was performed in five patients with tricuspid aortic valves (TAV) and in five patients with BAV. No patient had evidence of valvular dysfunction or aortic root pathology. A customized image analysis protocol was used to assess 3D aortic annular, valvular, and root geometry. Results Annular, sinus and sinotubular junction diameters and areas were similar in both groups. Coaptation length and area were higher in the TAV group (7.25 +/- 0.98 mm and 298 +/- 118 mm(2), respectively) compared to the BAV group (5.67 +/- 1.33 mm and 177 +/- 43 mm(2); P = .07 and P = .01). Cusp surface area to annular area, coaptation height, and the sub- and supravalvular tenting indices did not differ significantly between groups. Conclusions Single modality 3D echocardiography-based modeling allows for a quantitative description of the aortic valve and root geometry. This technique together with novel indices will improve our understanding of normal and pathologic geometry in the BAV population and may help to identify geometric predictors of adverse remodeling and guide tailored surgical therapy

The effect of surgical and transcatheter aortic valve replacement on mitral annular anatomy.

BACKGROUND: The effect of aortic valve replacement on three-dimensional mitral annular geometry has not been well described. Emerging transcatheter approaches for aortic valve replacement employ fundamentally different mechanical techniques for achieving fixation and seal of the prosthetic valve than standard surgical aortic valve replacement. This study compares the immediate impact of transcatheter aortic valve replacement (TAVR) and standard surgical aortic valve replacement (AVR) on mitral annular anatomy. METHODS: Real-time three-dimensional echocardiography was performed in patients undergoing TAVR using the Edwards Sapien valve (n = 10 [Edwards Lifesciences, Irvine, CA]) or AVR (n = 10) for severe aortic stenosis. Mitral annular geometric indexes were measured using Tomtec EchoView (Tomtec Imaging Systems, Munich, Germany) to assess regional and global annular geometry. RESULTS: Mixed between-within analysis of variance showed no differences between TAVR and AVR groups in any of the mitral annular geometric indices preoperatively. However, postoperative analysis did demonstrate an effect of AVR on geometry. Patients undergoing open AVR had significant decrease in annular height, septolateral diameter, mitral valve transverse diameter, and mitral annular area after valve replacement (p ≤ 0.006). Similar changes were not noted in the TAVR group. CONCLUSIONS: Mitral annular geometry is better preserved by TAVR than by AVR. Thus, TAVR may be a more physiologic approach to aortic replacement

Three-dimensional ultrasound-derived physical mitral valve modeling.

PurposeAdvances in mitral valve repair and adoption have been partly attributed to improvements in echocardiographic imaging technology. To educate and guide repair surgery further, we have developed a methodology for fast production of physical models of the valve using novel three-dimensional (3D) echocardiographic imaging software in combination with stereolithographic printing.DescriptionQuantitative virtual mitral valve shape models were developed from 3D transesophageal echocardiographic images using software based on semiautomated image segmentation and continuous medial representation algorithms. These quantitative virtual shape models were then used as input to a commercially available stereolithographic printer to generate a physical model of the each valve at end systole and end diastole.EvaluationPhysical models of normal and diseased valves (ischemic mitral regurgitation and myxomatous degeneration) were constructed. There was good correspondence between the virtual shape models and physical models.ConclusionsIt was feasible to create a physical model of mitral valve geometry under normal, ischemic, and myxomatous valve conditions using 3D printing of 3D echocardiographic data. Printed valves have the potential to guide surgical therapy for mitral valve disease