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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.

References

  1. Schultz CJ, Moelker A, Piazza N, Tzikas A, Otten A, Nuis RJ, Neefjes LA, van Geuns RJ, de Feyter P, Krestin G, et al. Three dimensional evaluation of the aortic annulus using multislice computer tomography: are manufacturer’s guidelines for sizing for percutaneous aortic valve replacement helpful? European Heart Journal 2010 31 849–856. (https://doi.org/10.1093/eurheartj/ehp534)

    Article  Google Scholar 

  2. Wang H, Hanna JM, Ganapathi A, Keenan JE, Hurwitz LM, Vavalle JP, Kiefer TL, Wang A, Harrison JK & Hughes GC. Comparison of aortic annulus size by transesophageal echocardiography and computed tomography angiography with direct surgical measurement. American Journal of Cardiology 2015 115 1568–1573. (https://doi.org/10.1016/j.amjcard.2015.02.060)

    Article  Google Scholar 

  3. Bonchek LI, Burlingame MW & Vazales BE. Accuracy of sizers for aortic valve prostheses. Journal of Thoracic and Cardiovascular Surgery 1987 94 632–634.

    Article  CAS  Google Scholar 

  4. Messika-Zeitoun D, Serfaty JM, Brochet E, Ducrocq G, Lepage L, Detaint D, Hyafil F, Himbert D, Pasi N, Laissy JP, et al. Multimodal assessment of the aortic annulus diameter: implications for transcatheter aortic valve implantation. Journal of the American College of Cardiology 2010 55 186–194. (https://doi.org/10.1016/j.jacc.2009.06.063)

    Article  Google Scholar 

  5. Jilaihawi H, Kashif M, Fontana G, Furugen A, Shiota T, Friede G, Makhija R, Doctor N, Leon MB & Makkar RR. Cross-sectional computed tomographic assessment improves accuracy of aortic annular sizing for transcatheter aortic valve replacement and reduces the incidence of paravalvular aortic regurgitation. Journal of the American College of Cardiology 2012 59 1275–1286. (https://doi.org/10.1016/j.jacc.2011.11.045)

    Article  Google Scholar 

  6. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. European Heart Journal Cardiovascular Imaging 2015 16 233–270. (https://doi.org/10.1093/ehjci/jev014)

    Article  Google Scholar 

  7. Sugeng L, Mor-Avi V, Weinert L, Niel J, Ebner C, Steringer-Mascherbauer R, Schmidt F, Galuschky C, Schummers G, Lang RM, et al. Quantitative assessment of left ventricular size and function: side-by-side comparison of real-time three-dimensional echocardiography and computed tomography with magnetic resonance reference. Circulation 2006 114 654–661. (https://doi.org/10.1161/CIRCULATIONAHA.106.626143)

    Article  Google Scholar 

  8. Tsang W, Bateman MG, Weinert L, Pellegrini G, Mor-Avi V, Sugeng L, Yeung H, Patel AR, Hill AJ, Iaizzo PA, et al. Accuracy of aortic annular measurements obtained from three-dimensional echocardiography, CT and MRI: human in vitro and in vivo studies. Heart 2012 98 1146–1152. (https://doi.org/10.1136/heartjnl-2012-302074)

    Article  Google Scholar 

  9. Sahn DJ, DeMaria A, Kisslo J & Weyman A. Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation 1978 58 1072–1083. (https://doi.org/10.1161/01.CIR.58.6.1072)

    Article  CAS  Google Scholar 

  10. Wiseth R, Rossvoll O, Levang OW, Skjaerpe T & Hatle L. Two-dimensional echocardiography for prediction of aortic valve prosthesis size. A comparative study of Medtronic-Hall and Carpentier-Edwards supra-annular valves. Scandinavian Journal of Thoracic and Cardiovascular Surgery 1993 27 87–92. (https://doi.org/10.3109/14017439309098696)

    Article  CAS  Google Scholar 

  11. Dashkevitch A, Blanke P, Siepe M, Pache G, Langer M, Schlensak C & Beyersdorf F. Preoperative assessment of aortic annulus dimensions: comparison of noninvasive and intraoperative measurement. Annals of Thoracic Surgery 2011 91 709–714. (https://doi.org/10.1016/j.athoracsur.2010.09.038)

    Article  Google Scholar 

  12. Kempfert J, Van Linden A, Lehmkuhl L, Rastan AJ, Holzhey D, Blumenstein J, Mohr FW & Walther T. Aortic annulus sizing: echocardiographic versus computed tomography derived measurements in comparison with direct surgical sizing. European Journal of Cardio-Thoracic Surgery 2012 42 627–633. (https://doi.org/10.1093/ejcts/ezs064)

    Article  Google Scholar 

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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

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Echo Research & Practice

ISSN: 2055-0464

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