Arq Bras Cardiol: Imagem cardiovasc. 2024; 37(2): e20240023
Transesophageal Echocardiography in Aortic Valve Stenosis: A Pre-Intervention “Toll”?
DOI: 10.36660/abcimg.20240023i
Aortic stenosis (AS) has become one of the most relevant valve diseases in cardiology care due to its increasing prevalence, resulting from the positive relationship between the preeminently degenerative etiology and global population aging. In Brazil, we highlight an epidemiological scenario characterized by an etiopathogenic coexistence: rheumatic fever and bicuspid valve disease in younger patients and calcific (degenerative) etiology in elderly patients. Regarding the natural history, AS leads to elevated cardiovascular morbidity and mortality in its symptomatic phase, with unfavorable prognosis when it is not diagnosed correctly and without timely intervention.–
Echocardiography is still a fundamental tool for diagnosis, allowing both evaluation of etiological characteristics and grading of AS severity using parameters such as aortic valve area, transvalvular pressure gradient, and peak aortic jet velocity. However, there are still questions related to the best window for acquiring echocardiographic data. Is the transesophageal window a necessary “toll” for all patients with AS for whom intervention is planned? In general, transesophageal echocardiography (TEE) has the potential to provide superior image quality to transthoracic echocardiography (TTE) in the evaluation of posterior cardiac structures close to the esophagus, for example, the mitral valve. In this case, the greater distance between these structures and the echocardiographic transducer might make evaluation through the transthoracic window difficult. However, the anterior anatomical topography of the aortic valve allows adequate analysis by TTE in most patients, thus avoiding exposure to sedation and possible complications of the transesophageal modality. Data from the literature have shown that TTE and TEE are comparable, mainly in the anatomical and etiological characterization of AS, with compatible results in estimating the valve area.– Nonetheless, there is evidence that the determination of the hemodynamic severity of AS, expressed by the transvalvular pressure gradient and aortic jet velocity, may be underestimated in TEE. Variations in blood volume and preload, conditioned by the fasting and sedation required for the exam, could justify these particularities in transesophageal evaluation.
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