Aortic annulus measurements: should we use multislice computed tomography, 3D echocardiography or MRI?

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

“…Cardiac magnetic resonance imaging, another noninvasive technique is also under investigation for aortic annular sizing. However, its major limitations are claustrophobia in some patients, complications from gadolinium use in chronic kidney disease which is a significant factor in the elderly with long‐standing aortic stenosis, and potential problems in those with cardiac devices (pacemaker and defibrillator) …”

Imaging the Aortic Annulus with Multi-Detector Computed Tomography and 3-Dimensional Transesophageal Echocardiography

“…Unlike TEE, MDCT can also image the entire aorta and iliac arteries, helping the operator to decide on the best access strategy for TAVR. 6 The disadvantage of an MDCT-based approach is the risk of contrast nephropathy in a patient population with a significant burden of comorbidities. 21 Exposure to ionizing radiation is often quoted as a potential drawback to the use of MDCT; however, in the current elderly population in whom TAVR is indicated, it should not be a prohibitive concern.…”

“…6 Large body habitus and high body weight negatively influence MDCT image quality and measurements. 6 OPTIMIZING RESULTS WITH IMAGING DATA Incidence of Paravalvular Regurgitation After Transcatheter Aortic Valve Replacement TEE performed immediately after TAVR demonstrate that paravalvular aortic regurgitation (PAR) occurs frequently, in at least 50% of cases. 28 Detaint and colleagues 10 demonstrated that in 77% of cases atrial regurgitation (AR) was mild (grade < 2/4).…”

“…These properties are particularly important when assessing the aortic annulus, which is a thin structure with imaging characteristics similar to that of the surrounding tissues. 6 Kempfert and colleagues 34 performed a study to evaluate accuracy of valve sizing performed either by MDCT or 2D echocardiography (transthoracic and TEE) by comparing these imaging-based measurements with direct intraoperative sizing in patients undergoing conventional surgical aortic valve replacements. Intraoperative direct sizing was considered the "gold standard."…”

“…Three-dimensional imaging techniques such as multidetector computed tomography (MDCT) and 3-dimensional (3D) transesophageal echocardiography (TEE) provide multiplanar imaging capabilities that allow precise measurements of the aortic annulus and aortic root. 6 The multiplanar capabilities of these 3D imaging modalities are essential owing to the complex, noncircular nature of the aortic annulus. These granular measurements influence eligibility of patients for TAVR, allow adequate prosthesis sizing, 7 and determine the success of implantation 8 as well as the likelihood of complications.…”