Assessment of the aortic annulus by multislice computed tomography, contrast aortography, and trans‐thoracic echocardiography in patients referred for transcatheter aortic valve implantation

Abstract

We found significant differences in the dimensions of the aortic annulus measured by MSCT, CA, and TTE. Interobserver variability for TTE and CA was substantially higher compared with MSCT.

Two-Year Outcomes after Transcatheter or Surgical Aortic-Valve Replacement

“…Recently, the routine use of threedimensional imaging techniques has improved annulus sizing, resulting in better selection of properly sized valves. [33][34][35][36][37] In addition, the selective use of post-TAVR dilation of the transcatheter valve with slightly larger balloons may reduce im- mediate paravalvular aortic regurgitation during TAVR, but the risks of aortic rupture, increased central aortic regurgitation, and increased embolic events must be considered. Future generations of TAVR devices with improved subannular fixation designs or external space-filling materials may also reduce incomplete apposition.…”

Aortic Annulus Diameter Measurement: What Is the Best Modality?

“…5,6,[13][14][15][16][17][18][19] Severe calcification, 9,13,14) three dimension structure of the aortic annulus, 9,13) and so on has been proposed concerning the reason why the echocardiography underestimated the aortic annulus diameter. Recently, the elliptical shape of the aortic annulus [4][5][6]13,[15][16][17]19,20) or left ventricular outflow tract has been pointed out, and it may be one of the reasons for the underestimation of the aortic annulus by TTE, however, there may be others. Schultz CJ 4) or Tzikas A 19) advocated that the measured distance using echocardiography might decline to the true diameter.…”

Multislice computer tomography (MSCT) for the optimisation of transcatheter aortic valve implantation (TAVI)

“…The TTE parasternal long axis view and TEE 3-chamber, both of which are routinely used for sizing, allow only measurement of an oblique sagittal diameter, which approximates the minimum diameter of the aortic annulus. (27) The coronal, which approximates the maximum diameter, cannot be measured on TTE/TEE (6,28) (Figure 3). …”

“…(26) The annulus diameter measured a TTE PLAX view or TEE 3 chamber view falls in between the mean and the minimum diameter, and the coronal diameter from contrast aortography falls in between the mean and maximum diameters. (27,28) The differences between the imaging modalities represent anatomically different dimensions of a complex structure rather than discrepancies, (Figure 3), whereas a lesser contribution may be expected from measurement variability and -method. Figure 3 shows how these measurements relate to one another based on an axial image of the aortic annulus.…”