PREDICTION OF HOMOGRAFT AORTIC-VALVE SIZE BY TRANSTHORACIC AND TRANSESOPHAGEAL 2-DIMENSIONAL ECHOCARDIOGRAPHY

To avoid the problem of patient valve mismatch we assessed the reliabi lity of echocardiographic measurements in selecting an appropriate-siz ed homograft aortic valve. Preoperative transthoracic echocardiography (TTE) was performed in 26 consecutive patients undergoing aortic valu e replacement with a cryopreserved human homograft; 19 of the patients also had intraoperative transesophageal echocardiography (TTE). The d iameters of Left ventricular outflow tract (LVOT), aortic annulus, sin uses of Valsalva, and ascending aorta were measured by the same techni que in all patients. There was a strong correlation between LVOT diame ter measured by intraoperative TEE and homograft aortic valve size sel ected by the surgeon (r = 0.91, P < 0.001). A good correlation was als o found between LVOT measured by preoperative TTE and the homograft va lve size (r = 0.82, P = 0.001). The correlation between the homograft aortic valve size and the diameter of aortic annulus was less optimal; the correlation was poor for the diameter of aorta measured at the le vel of the sinuses of Valsalva and ascending aorta. Measurement of the LVOT diameter by intraoperative TEE and preoperative TTE is reliable and clinically useful for the preparation. of homograft aortic valves and selection of proper size, particularly in those patients undergoin g repeat aortic valve replacement, with heavily calcified aortic valve or with ascending aortic aneurysm.