CONTRIBUTION OF MULTIDIMENSIONAL TRANSESO PHAGEAL ECHOCARDIOGRAPHY INTHE DETERMINATION OF THE ORIFICIAL SURFACE-AREA OF AORTIC-STENOSIS INADULTS - A SERIES OF 85 CASES

The objective of this study was to assess the validity of multidimensi onal transoesophageal echocardiography (TOE) in the determination of t he orificial surface area of aortic stenosis (AS) in 85 patients, usin g as a reference the surface area calculated on transthoracic ultrason ography (TTU) by applying the continuity principle (n=75) and/or by ha emodynamic studies using Gorlin's formula (n=40). Planimetry was able to be performed in 78 of the 85 patients (92 %). Planimetry was imposs ible in 7 patients with massive calcification of the aortic orifice (n =5) or posterior valve (n=2). The mean value of the selected angle was 45 +/- 13 degrees (0 to 78 degrees). An excellent correlation was obs erved between aortic surface area (ASA) measured by multidimensional T OE and TTU (r=0.94; y=0.90x +/- 0.10; SEE=0.10 cm(2); p<0.001). Simila rly, the ASA on multidimensional TOE was also well correlated with the haemodynamic surface area (r=0.90, y=0.94x +/- 0.05; SEE=0.09 cm(2); p<0.001). The correlations between multidimensional TOE and TTU measur ements (n=26; r=0.96; y=0.85x +/- 0.11; SEE=0.07 cm(2); p<0.001) and c ardiac catheterization (n=13; r=0.92; y=0.77x +/- 0.7; SEE=0.09 cm(2); p<0.001) remained satisfactory in patients with associated aortic inc ompetence, Multidimensional TOE identifies cases of AS with an ASA on TOE or haemodynamic studies less than or equal to 0.75 cm(2) with sens itivities of 93 % and 92 %, respectively, and a specificity of 100 %. Overall, multidimensional TOE allows a precise and reliable evaluation of ASA in the great majority of cases of AS.