Assessment of Left Ventricular Outflow Tract Dynamics During the Cardiac Cycle by Three-Dimensional Echocardiography

Mariano L. Falconi, Diego Funes, Anibal A. Arias, Rodrigo Bagnati, Guillermo Jaimovich, Mauro L. Giacomini, Pablo F. Oberti, Arturo M. Cagide



Anatomical and anatomo-functional disorders of the left ventricular outflow tract (LVOT) are subject of numerous studies. However, LVOT normal dynamic behavior, especially in procedures involving this area is also relevant, and may be evaluated with new three-dimensional imaging methods.


The aim of this study was to assess LVOT dynamics during the cardiac cycle with three-dimensional transesophageal echocardiography (TEE).

Material and methods

Forty two patients referred for transesophageal echocardiography (TEE) were prospectively included. All TEE studies were performed with a three-dimensional transesophageal probe. For complete volume images, 4 gated beats were acquired for off-line analysis. The cardiac cycle was divided in proto-systole (S1), mid-systole (S2) and tele-systole (S3) and proto-diastole (D1), mid-diastole (D2) and tele-diastole (D3). The LVOT area was measured by planimetry of the short axis, through orthogonal sections to the long axis of the LVOT in each phase.


Mean age was 67±10 years, and 63% of the patients were male. The LVOT area (cm2) in the different phases of the cardiac cycle was: S1: 4.44±1.02; S2: 4.15±0.91; S3: 3.9±0.89; D1: 3.76±0.98; D2: 3.89±1.04; D3: 4.34±1.11. Maximum area was observed in S1, corresponding to the closed position of the anterior leaflet of the mitral valve (AL) and reduced motion of the interventricular septum (IVS) towards LVOT; minimum area was obtained in D1 consistent with a certain persistence of IVS in the LVOT and maximal AL opening occupying part of the LVOT. Total area reduction was 15±11% (p<0.0001), changing the LVOT from a partially elliptical or circular shape (systole) to a markedly elliptical or semilunar one (diastole).


The LVOT changes its area and shape during the cardiac cycle, depending basically on the movement of the IVS (during systole) and mitral valve opening (during diastole).

Rev Argent Cardiol 2012;80.




Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP, et al; American Society of Echocardiography; European Association of Echocardiography. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. J Am Soc Echocardiogr 2009;22:1-23.

Piazza N, de Jaegere P, Schultz C, Becker AE, Serruys PW, Anderson RH. Anatomy of the aortic valvar complex and its implications for transcatheter implantation of the aortic valve. Circ Cardiovasc Interv 2008;1:74-81.

Doddamani S, Bello R, Friedman MA, Banerjee A, Bowers JH Jr, Kim B, et al. Demonstration of left ventricular outflow tract eccentricity by real time 3D echocardiography: implications for the determination of aortic valve area. Echocardiography 2007;24:860-6.

Burgstahler C, Kunze M, Löffler C, Gawaz MP, Hombach V, Merkle N. Assessment of left ventricular outflow tract geometry in non-stenotic and stenotic aortic valves by cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2006;8:825-9.

Otani K, Takeuchi M, Kaku K, Sugeng L, Yoshitani H, Haruki N, et al. Assessment of the aortic root using real-time 3D transesophageal echocardiography. Circ J 2010;74:2649-57.

Doddamani S, Grushko MJ, Makaryus AN, Jain VR, Bello R, Friedman MA, et al. Demonstration of left ventricular outflow tract eccentricity by 64-slice multi-detector CT. Int J Cardiovasc Imaging 2009;25:175-81.

Delgado V, Bax JJ. Classical methods to measure aortic valve area in the era of new invasive therapies: still accurate enough? Int J Cardiovasc Imaging 2009;25:183-5.

Tops LF, Wood DA, Delgado V, Schuijf JD, Mayo JR, Pasupati S, et al. Noninvasive evaluation of the aortic root with multislice computed tomography implications for transcatheter aortic valve replacement. JACC Cardiovasc Imaging 2008;1:321-30.

Garcia D, Dumesnil JG, Durand LG, Kadem L, Pibarot P. Discrepancies between catheter and Doppler estimates of valve effective orifice area can be predicted from the pressure recovery phenomenon: practical implications with regard to quantification of aortic stenosis severity. J Am Coll Cardiol 2003;41:435-42.

Wippermann CF, Schranz D, Stopfkuchen H, Huth R, Freund M, Jüngst BK. Evaluation of the valve area underestimation by the continuity equation. Cardiology 1992;80:276-82.

Oh JK, Taliercio CP, Holmes DR Jr, Reeder GS, Bailey KR, Seward JB, et al. Prediction of the severity of aortic stenosis by Doppler aortic valve area determination: prospective Doppler-catheterization correlation in 100 patients. J Am Coll Cardiol 1988;11:1227-34.

Full Text


  • There are currently no refbacks.

Licencia Creative Commons
The documents published in this journal are under the licencia Creative Commons Atribución-NoComercial-Compartir-Igual 2.5 Argentina.

Revista argentina de cardiología. ISSN en línea 1850-3748. Argentine journal of cardiology (English ed. Online ISSN 2314-2286) Sociedad Argentina de Cardiología. Azcuénaga 980 (C1115AAD),Ciudad Autónoma de Buenos Aires, República Argentina. Tel. (54 11) 4961-6027/8/9 Fax: 4961-6020