Manish Hinduja1, Vivek Wadhawa2, Sandip Singh Rana3, Harkant Singh4, Parmindrer Singh5, Manphool Singhal6, Chirag Doshi7, Amber Malhotra8
Precise preoperative assessment of aortic annulus diameter is essential for sizing of aortic valve especially in patients planned for transcatheter aortic valve replacement. Computed Tomographic (CT) and echocardiographic measurements of the aortic annulus vary because of elliptical shape of aortic annulus. This study was undertaken to compare the measurement of aortic annulus intraoperatively with preoperative noninvasive methods in patients undergoing aortic valve replacement.
MATERIALS AND METHODS
Aortic annulus diameter was measured with cardiac CT and Transesophageal Echocardiography (TEE) prior to open aortic valve replacement in 30 patients with aortic valve stenosis. In CT, aortic annulus dimensions were measured in coronal plane, sagittal oblique plane and by planimetry. Both 2-dimensional and 3-dimensional TEE were used. These were compared with intraoperative measurements done by valve sizers and Hegar dilators. Pearson analysis was applied to test for degree of correlation.
CT in coronal and sagittal oblique plane tends to overestimate the diameter of aortic annulus when compared with intraoperative measurements (coefficient of relation, r = 0.798 and 0.749, respectively). CT measurements in single oblique plane showed a weaker correlation with intraoperative measurements than 3D TEE and 2D TEE (r = 0.917 and 0.898, respectively). However, CT measurements by planimetry method were most correlating with the intraoperative measurements (r = 0.951).
Noninvasive investigations with 3-dimensional views (CT-based measurement employing calculated average diameter assessment by planimetry and 3-dimensional TEE) showed better correlation with intraoperative measurement of aortic annulus. CT-based aortic annulus measurement by planimetry seems to provide adequate dimensions most similar to operative measurements.