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Purpose: Percutaneous aortic valve implantation (AVI) has become a valid alternative to conventional surgery in selected high-risk patients (pts), however some major complications have been reported including coronary ostia impairment due to the presence of low coronary ostia and the occluding effect of aortic leaflets displacement by prosthetic implantation. Moreover a reduction of the distance between aortic valve annulus and left main coronary artery ostium (AN-LM) has been demonstrated due to remodeling of the aortic root in calcific aortic stenosis. Therefore a careful preoperative evaluation of AN-LM is necessary and it is usually obtained by computed tomography (CT), the gold standard in this context, but cannot be accurately performed in arrhythmic pts. In the AVI pts management, 3DTEE is known to be very useful. Aim of our study was to analyze the feasibility of AN-LM 3DTEE evaluation and its accuracy compared with CT values.Methods: In 103 pts with aortic valve stenosis candidate to AVI, 3DTEE and CT AN-LM measurements were obtained and compared. Inter and intra-observer variability were calculated. Max (D1) and min (D2) AN diameters were also evaluated. AN-LM 3DTEE measurements were calculated by 3D analysis software (Figure).Results: In all pts, 3DTEE was obtained and left main ostium visualized. 3DTEE (13.6±2.2mm) and CT (13.9±2mm) AN-LM strictly correlated (r=0.82, p<0.001, bias -0.3, LOA 2.7). No significant differences were observed between 3DTEE and CT D2 (21.4±2.0vs21.2±2.3mm) and D1 (24.5±2.3vs25.4±2.7mm). Inter and intra-observer variability in AN-LM 3DTEE measurements (30pts) were respectively 2.6% and 1.9%.Conclusions: evaluation of AN-LM by 3DTEE was feasible and accurate and may be a valid alternative to CT in cases with inability or contraindication to obtain CT data.