1032 FEASIBILITY AND RELIABILITY OF COMPREHENSIVE THREE DIMENSIONAL TRANSESOPHAGEAL ECHOCARDIOGRAPHY SCREENING PROCESS FOR TRANSCATHETER MITRAL VALVE REPLACEMENT. (15th December 2022)

• Record Type: Journal Article
• Authors: Boccellino, Antonio; Piroli, Francesco; Ingallina, Giacomo; Rolando, Marco; Melillo, Francesco; Francesco, Ancona; Stella, Stefano; Biondi, Federico; Baldetti, Luca; Palmisano, Anna; Esposito, Antonio; Denti, Paolo; Montorfano, Matteo; Maisano, Francesco; Castiglioni, Alessandro; Agricola, Eustachio
• Is Part Of: European heart journal supplements. Volume 24(2022)Supplement K
• Publication Date: 2022-12-15
• Subjects: Cardiology -- Periodicals; Cardiology -- Europe -- Periodicals; 616.12005
• DOI: 10.1093/eurheartjsupp/suac121.162
• Languages: English
• ISSNs: 1520-765X

Abstract

Abstract: The procedural planning of transcatheter mitral valve replacement (TMVR) requires a specific imaging assessment to establish patient eligibility. Computed tomography (CT) is considered the reference method. In this setting, data regarding the role of transesophageal echocardiography (TEE) are lacking. Aims: To evaluate the feasibility and reliability of a comprehensive 3D-TEE screening in TMVR candidates. Methods: we performed a retrospective observational study including 72 consecutive patients who underwent a pre-procedural CT and 3D-TEE for TMVR evaluation. The measurements of mitral annulus (MA), length of anterior mitral leaflet (AML), native left ventricular outflow tract (LVOT) and predicted neo-LVOT acquired with CT and 3DTEE were compared using a novel semi-automated software for post processing analysis (3mensio Structural Heart 10.1 - 3mSH, Pie Medical Imaging, Bilthoven, Netherlands). The final suitability decision was given by the valve manufacturer based on CT measurements and clinical conditions. Results: Among 72 patients screened, all patients had adequate image quality for 3D-TEE analysis. 3D-TEE and CT measurements for AML length (r=0.97), MA area (r=0.90), perimeter (r=0.68), anteroposterior (r=0.88) and posteromedial-anterolateral (r=0.74) diameters were found highly correlated, as well as for native LVOT (r=0.86) and predicted neo-LVOT areas (r=0.96) (all P -values <0.0001). An almost perfect agreement among CT and 3d TEE was found in assessing the eligibility for TMVR implantation (Cohen Kappa 0.83, p<0.001). Conclusions: 3D-TEE appraisements showed good correlations with CT measurements and high accuracy to predict TMVR screening success. Central Illustration . Mitral annulus segmentation and neo-LVOT area measurement performed by means of the 3mensio software (Pie Medical Imaging, Bilthoven, Netherlands) in a step-by-step fashion by TEE and CT imaging. After the virtual simulation of a valve implantation, the minimal systolic neo-LVOT area is manually measured by planimetry on a plane orthogonal to the centerline.