PREDICTION OF STENTLESS AORTIC BIOPROSTHESIS SIZE WITH TRANSESOPHAGEAL ECHOCARDIOGRAPHY AND MAGNETIC-RESONANCE-IMAGING

Background and aims of the study: During stentless bioprosthetic aorti c valve replacement, ischemic time may be decreased by the non-invasiv e prediction of bioprosthesis size, allowing earlier commencement of p rosthesis preparation. In this study we examine whether the addition o f transesophageal echocardiography (TEE) to transthoracic echocardiogr aphy (TTE) aids in the prediction of stentless bioprosthesis aortic va lve size. We also report our preliminary experience with the use of ma gnetic resonance imaging (MRI) in bioprosthetic valve size prediction. Methods: Eight patients in whom elective aortic valve replacement wit h a Toronto SPV valve was planned underwent preoperative TTE and MRI, and intraoperative TEE. Results: In all cases the combination of TTE a nd TEE correctly predicted the size of Toronto SPV valve inserted. In three cases, TEE led to a revision of the TTE-based prediction. The ne ed for sinotubuloplasty in two patients was correctly predicted by bot h TTE and TEE. MRI of the aortic annulus correctly predicted valve siz e in three of four cases, but could not reliably identify the sinotubu lar junction. Conclusions: In aortic valve replacement the accuracy of prediction of stentless bioprosthesis size is improved by the additio n of TEE to TTE.