3DE of the Spectrum of Native Aortic Valve and Subvalvular Diseases and Pathological Correlations

Assessment of the aortic valve (AV) and sub or supravalvular anatomy by two-dimensional echocardiography (2DE) in the conventional long and short-axis views of the AV and aortic root provides limited views that are subject to distortion with off axis imaging. In contrast, three-dimensional echocardiography (3DE) and in particular 3D transesophageal echocardiography (3D TEE), provides enface views of the entire AV, aortic root, and subvalvular chamber. The added depth and spatial dimensions provided by 3DE allow for the entire AV complex to be viewed in multiple perspectives without distortion of actual anatomy or pathology, and for better characterization of supravalvular or subvalvular pathologies such as the circumferential extent of subaortic membranes. Moreover, multiplanar reconstruction (MPR) of 3D data sets allows for accurate quantification of anatomy or pathology of interest such as the aortic annulus dimensions, severity of subvalvular stenosis, and severity of aortic regurgitation, among others. For pre-TAVR planning, 3D TEE is comparable to multidetector computed tomography and in patients with renal dysfunction, 3D TEE may be potentially advantageous for TAVR measurements because of the lack of contrast exposure.