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

Background: Preoperative knowledge of the aortic annular diameter coul d enable the preoperative selection and preparation of an appropriatel y 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 preope rative aortic annular measurements for the selection and preparation o f adequately sized homograft aortic valves and to retrospectively eval uate 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 perf ormed before the operation by an experienced reader who used a combina tion of transthoracic and multiplane transesophageal images of 25 pati ents (mean age 52 +/- 13 years) referred for homograft aortic valve re placement. Measurements were also performed retrospectively by three a dditional readers with different levels of training in echocardiograph y. These readers acquired aortic annular diameters from prerecorded ta pes and obtained measurements from each echocardiographic modality ind ependently. All values were compared with the surgical measurement obt ained with a ring valve sizer. Results: With the combined echocardiogr aphic approach, excellent agreement was found between preoperative ech ocardiographic and surgical measurements (mean difference +/- 2 standa rd deviations = 0.2 +/- 1.4 mm). All echocardiographic data were found to be within 2 mm of the surgical measurement. These measurements wer e used to select and prepare the aortic homograft valve before inserti on. The accuracy of annular measurements appeared to increase in paral lel to the level of experience. The aortic annular measurements obtain ed retrospectively by a second experienced reader were more accurate w ith the use of transesophageal than with transthoracic echocardiograph y (p < 0.01). In contrast, the echocardiographic modality had no influ ence on the accuracy of measurements of less experienced readers (p > 0.2). Conclusions: Preoperative measurement of the aortic annular diam eter by transthoracic and multiplane transesophageal echocardiography is accurate and clinically feasible. Preoperative knowledge of the aor tic annular diameter may be used to select and prepare the aortic homo graft, improving valve availability and reducing ischemic time.