Validation of Transesophageal Echocardiographic In Vitro Measurements for Bioprosthetic Aortic Valves: Implications for Percutaneous Valve-in-Valve Therapy

Background Percutaneous valve-in-valve therapy has become an important treatment option for failing bioprosthetic heart valves. Accurate assessment of valve internal diameter (ID) is essential for effective and safe treatment. These data may not be available in an individual patient, or the manufacturer-supplied dimensions may be incorrect because they do not allow for the space occupied by valve leaflet material. Methods In total, 2,332 two-dimensional and three-dimensional transesophageal echocardiographic in vitro measurements were performed using both Philips iE33 and GE Vivid E9 systems with a range of system settings on 53 bioprosthetic valves in all available sizes. Two-dimensional echocardiographic ID measurements were made in two orthogonal planes at the level of the sewing ring, and similar three-dimensional measurements were generated from multiplane reconstructions. They were compared with both manufacturer-supplied valve ID (MID) and the true ID (TID) measured with Hegar dilators. Results Both the iE33 and the Vivid 9 provided comparable valve ID measurements. TID was statistically significantly smaller than MID ( P Conclusions Transesophageal echocardiographic valve ID measurements compare well with TID, which is overestimated by MID. These findings have potentially important implications for valve-in-valve procedures because an inaccurate measurement of TID might lead to the wrong choice of implanted valve.