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

Fortunata Condemi, Vinnie N. Bapat, Silvia Gianstefani, Norman Catibog, Alexandros Papachristidis, Abdel Douiri, Francesco Romeo, Mark J. Monaghan*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


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 < .001). All echocardiographic measurements were closer to TID than to MID. Two-dimensional measurements were closest to TID because of higher spatial resolution. 

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.

Original languageEnglish
Pages (from-to)267–275
Number of pages9
JournalJournal of The American Society of Echocardiography
Issue number3
Early online date19 Dec 2015
Publication statusPublished - Mar 2016


  • Failed aortic bioprosthesis
  • Internal diameter measurement
  • Ultrasound imaging
  • Valve-in-valve implantation

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