Aortic Annulus Diameter Measurement: What Is the Best Modality?

Abstract

Purpose: The purpose of this study was to clarify the most suitable method to measure the aortic annulus diameter. Patients and Methods: Fifty-five patients, who had undergone aortic valve replacement at Miyazaki University Hospital between April 2008 and May 2011, were included in this study. The maximum diameter of the sizing tool that could be inserted into the left ventricle through the annulus had been predicted, based on the diameter measured by each modality. Agreement with surgery and each imaging modality, namely transthoracic echocardiography, multidetector computed tomography and contrast angiography, were compared using Bland-Altman analysis. Results: The predicted aortic annulus diameter, based on the diameter measured by transthoracic echocardiography, multidetector computed tomography and contrast angiography, was 20.3 ± 2.50, 23.9 ± 3.19, and 23.5 ± 3.55 mm, respectively, whereas, the diameter measured at surgery was 23.7 ± 2.99 mm. Predicted aortic annulus diameter measured by multidetector computed tomography best agreed with that measured at surgery. Conclusion: We conclude that the aortic annulus diameter, measured by multidetector computed tomography, is the best modality to measure the aortic annulus diameter.

Three‐dimensional transesophageal echocardiography is an attractive alternative to cardiac multi‐detector computed tomography for aortic annular sizing: Systematic review and meta‐analysis

“…MDCT demonstrates precise annular sizing, unobscured evaluation for the annular-coronary ostial distance, and peripheral arterial system evaluation to ensure optimal access. [51][52][53][54][55] The downsides are ionized radiation risk, inability to be used with morbidly obese patients, patients with claustrophobia, and contrast exposure. The overall incidence of contrast-induced kidney injury among patients evaluated for TAVR by MDCT is 7%-10.5%.…”

“…There is no agreement yet as each modality has its pros and cons. MDCT demonstrates precise annular sizing, unobscured evaluation for the annular‐coronary ostial distance, and peripheral arterial system evaluation to ensure optimal access . The downsides are ionized radiation risk, inability to be used with morbidly obese patients, patients with claustrophobia, and contrast exposure.…”

Accuracy of Aortic Annulus Diameter Measurement: Comparison of Multi-Detector CT, Two- and Three-Dimensional Echocardiography

“…Therefore, the measurement of the linear diameter between right coronary and left coronary cusps by 2D‐TTE is not ideal. Yano et al also mentioned another possible reason why 2D‐TEE underestimates the aortic annulus size . They described the problems of the measurement between two bottoms of the aortic root by 2D‐TTE because the true diameter should not pass between two bottoms of the aortic root, but through one bottom of the cusp and the opposite side of the commissure.…”

Transcatheter Aortic Valve Replacement

“…60,61,100,104,109 Some studies have demonstrated a probable underestimation of the annular size by echocardiography compared with MDCT, which may lead to implantation of an undersized valve and an increase in the risk for PAI. 60,61,100,113 Despite this, the measurement of the AV annulus obtained by 2D TTE or TEE modalities have proved to be adequately accurate, resulting in excellent overall procedural success. 59,110 Because the gold-standard is not yet established, a multimodality approach is recommended for the assessment of the AV annulus size and severity of PAI.…”