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J Thorac Cardiovasc Surg 1996;112:954-961
© 1996 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

FEASIBILITY OF AORTIC DIAMETER MEASUREMENT BY MULTIPLANE TRANSESOPHAGEAL ECHOCARDIOGRAPHY FOR PREOPERATIVE SELECTION AND PREPARATION OF HOMOGRAFT AORTIC VALVES

From the Cardiology Section, Department of Medicine, and the Section of Cardiac Surgery, Department of Surgery, University of Chicago, Chicago, Ill.

Received for publication Nov. 7, 1995 Revisions requested Dec. 26, 1995; revisions received Feb. 12, 1996 Accepted for publication March 25, 1996. Address for reprints: Roberto M. Lang, MD, University of Chicago Medical Center, 5841 S. Maryland Ave., MC5084 Chicago, IL 60637.

Abstract

Background: Preoperative knowledge of the aortic annular diameter could enable the preoperative selection and preparation of an appropriately sized homograft aortic valve.

Objective: The aims of this study were to prospectively determine whether the combined use of transthoracic and multiplane transesophageal echocardiography allows accurate preoperative aortic annular measurements for the selection and preparation of adequately sized homograft aortic valves and to retrospectively evaluate the influence of the echocardiographic approach (transthoracic vs transesophageal) and the reader's level of experience on the accuracy of these measurements.

Methods: Aortic annular measurements were performed before the operation by an experienced reader who used a combination of transthoracic and multiplane transesophageal images of 25 patients (mean age 52 ± 13 years) referred for homograft aortic valve replacement. Measurements were also performed retrospectively by three additional readers with different levels of training in echocardiography. These readers acquired aortic annular diameters from prerecorded tapes and obtained measurements from each echocardiographic modality independently. All values were compared with the surgical measurement obtained with a ring valve sizer.

Results: With the combined echocardiographic approach, excellent agreement was found between preoperative echocardiographic and surgical measurements (mean difference ± 2 standard deviations = 0.2 ± 1.4 mm). All echocardiographic data were found to be within 2 mm of the surgical measurement. These measurements were used to select and prepare the aortic homograft valve before insertion. The accuracy of annular measurements appeared to increase in parallel to the level of experience. The aortic annular measurements obtained retrospectively by a second experienced reader were more accurate with the use of transesophageal than with transthoracic echocardiography (p < 0.01). In contrast, the echocardiographic modality had no influence on the accuracy of measurements of less experienced readers (p > 0.2).

Conclusions: Preoperative measurement of the aortic annular diameter by transthoracic and multiplane transesophageal echocardiography is accurate and clinically feasible. Preoperative knowledge of the aortic annular diameter may be used to select and prepare the aortic homograft, improving valve availability and reducing ischemic time. (J THORACCARDIOVASCSURG1996;112:954-61)

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