Usefulness of Three Dimensional Transesophageal Echocardiography in Balloon Aortic Valvuloplasty for Patients with Aortic Stenosis

Backgrounds: Some studies have shown that balloon aortic valvuloplasty (BAV) can improve the mortality of patients with severe aortic stenosis (AS) and the efficacy of BAV depends on the final aortic valve area (AVA). However, it is uncertain how to determine the final balloon size for safely acquiring the larger AVA. The purpose of this study was to investigate whether antegrade BAV based on the aortic annular size using three-dimensional transesophageal echocardiography (3DTEE) can acquire larger AVA compared with conventional two-dimensional TEE (2DTEE).
Methods: We studied consecutive 16 patients with AS underwent antegrade BAV using real-time 3DTEE. The annular size was calculated as the 2DTEE diameter or the 3D TEE diameter. The INOUE balloon was inflated incrementally up to the annular size based on 2DTEE, then up to the size based on 3DTEE. AVA was analyzed with 3DTEE at each stage.
Results: The annular diameter was larger in 3DTEE than in 2D TEE (23.1±2.5mm vs. 21.1±2.4mm, p<0.0001). The AVA after dilation up to the size based on 2DTEE was larger than the AVA before BAV (0.82±0.13cm² vs. 0.62±0.14cm², p<0.0001). The AVA after dilation up to the size based on 3DTEE (0.95±0.12cm²) was larger than based on 2D TEE or before BAV (p<0.0001, respectively). There was no complication caused by over dilation of BAV balloons.
Conclusion: Antegrade BAV based on the annular size with 3DTEE can acquire larger AVA compared with conventional 2DTEE in patients with AS. The 3DTEE-guided BAV may help improve the mortality of patients in whom surgical or transcatheter aortic valve replacement is not eligible in spite of having severe AS.