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Preoperative aortic annulus size assessment by transthoracic echocardiography compared to the size of surgically implanted aortic prostheses

Echo Research & Practice volume 6, pages 37–41 (2019)Cite this article

Abstract

Objectives: The aortic annulus diameter measured by transthoracic echocardiography yields lower values than by computed tomography, and echo-based selection of transcatheter aortic valve prosthesis size has been implied to result in more frequent paravalvular leakage. We investigated the relation of preoperative annulus diameter by echo with the ring size of the aortic prosthesis chosen by direct assessment during open-heart aortic valve replacement.

Methods: Preoperative annulus diameter by echo (from parasternal long-axis cross-sections of the left ventricular outflow tract and aortic valve) and implanted prosthetic diameter (tissue annulus diameter, determined intraoperatively using a sizing instrument) were compared retrospectively in 285 consecutive patients undergoing open-heart aortic valve replacement.

Results: A total of 285 prostheses (240 biologic and 45 mechanical) were implanted, with prosthetic diameter ranging between 19 and 27 mm. There was a significant linear correlation (P < 0.0001) with r = 0.51, between preoperative annulus diameter by echo (mean 21.8 ± 2.8 mm) and prosthetic diameter (22.9 ± 1.7 mm). Preoperative annulus diameter of patients receiving prostheses no. 21, 23 and 25 mm aortic prostheses (the most frequent prosthesis sizes) were significantly different (P < 0.001) from each other. On average, preoperative annulus diameter by echo underestimated prosthetic diameter by a bias of 1.07 mm.

Conclusion: Our data confirm that preoperative echo assessment of the aortic valve may slightly underestimates the optimal surgical prosthesis diameter for the aortic valve annulus.

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This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

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Authors and Affiliations

  1. Department of Cardiology, Uppsala University Hospital, Uppsala, Sweden

    I. J. Ingimarsdóttir MD PhD

  2. Department of Cardiothoracic Surgery, Uppsala University Hospital, Uppsala, Sweden

    L. Hellgren Johansson MD PhD

  3. Department of Medical Sciences, Clinical Physiology, Uppsala University and Uppsala University Hospital, Uppsala, Sweden

    F. A. Flachskampf MD PhD

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  1. I. J. Ingimarsdóttir MD PhD
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  2. L. Hellgren Johansson MD PhD
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  3. F. A. Flachskampf MD PhD
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Correspondence to F. A. Flachskampf MD PhD.

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Ingimarsdóttir, I.J., Hellgren Johansson, L. & Flachskampf, F.A. Preoperative aortic annulus size assessment by transthoracic echocardiography compared to the size of surgically implanted aortic prostheses. Echo Res Pract 6, 37–41 (2019). https://doi.org/10.1530/ERP-19-0010

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  • DOI: https://doi.org/10.1530/ERP-19-0010

Key Words

  • aortic valve
  • aortic valve replacement
  • prosthetic valve
  • echocardiography

Echo Research & Practice

ISSN: 2055-0464