Measurement Of Aortic Annulus Diameter Research Articles

Automatic measurement of aortic annulus diameter in 3-dimensional Transoesophageal echocardiography

BackgroundTranscatheter aortic valve implantation involves percutaneously implanting a biomechanical aortic valve to treat severe aortic stenosis. In order to select a proper device, precise sizing of the aortic valve annulus must be completed.MethodsIn this paper, we describe a fully automatic segmentation method to measure the aortic annulus diameter in patients with aortic calcification, operating on 3-dimensional transesophageal echocardiographic images. The method is based on state estimation of a subdivision surface representation of the left ventricular outflow tract and aortic root. The state estimation is solved by an extended Kalman filter driven by edge detections normal to the subdivision surface.ResultsThe method was validated on echocardiographic recordings of 16 patients. Comparison against two manual measurements showed agreements (mean ±SD) of -0.3±1.6 and -0.2±2.3 mm for perimeter-derived diameters, compared to an interobserver agreement of -0.1±2.1 mm.ConclusionsWith this study, we demonstrated the feasibility of an efficient and fully automatic measurement of the aortic annulus in patients with aortic disease. The algorithm robustly measured the aortic annulus diameter, providing measurements indistinguishable from those done by cardiologists.

CT scan measurement of aortic annulus diameter before TAVI: Which is the most reliable method?

CT scan measurement of aortic annulus diameter before TAVI: Which is the most reliable method?

Comparison of two- and three-dimensional transthoracic echocardiography for measurement of aortic annulus diameter in children

Accurate evaluation of aortic root geometry is necessary in congenital aortic valve lesions in children, to guide surgical or angiographical intervention. To compare aortic annulus diameters measured by two- and three-dimensional transthoracic echocardiography (2D- and 3D-TTE), to determine the feasibility and reproducibility of 3D imaging and assess the dynamic changes during the cardiac cycle. Thirty children without heart disease were prospectively included. Two orthogonal aortic annulus diameters were measured offline using multiplanar reconstruction in diastole and in systole and were compared with the measurement of the aortic annulus diameter by 2D-TTE. Mean age was 11±3.6 years. Feasibility of 3D imaging was 100%. The coefficients of intra- and interobserver variability were 3.5% and 6%, respectively. The 2D mean diameter was significantly smaller than the 3D maximum diameter in systole (1.94 vs. 2.01mm; p=0.005). 2D and 3D measurements were well correlated (p<0.0001). The maximum and minimum diameters in 3D were significantly different both in systole and in diastole (p<0.001) underlining an aortic annulus eccentricity. The mean aortic annulus diameters were not significantly different between systole and diastole, with important individual variability during the cardiac cycle. This study demonstrated the feasibility and reproducibility of 3D-TTE for the assessment of the aortic annulus diameter in a normal paediatric population. Because of an underestimation of the maximum diameter by 2D-TTE and the asymmetry of the aortic annulus, 3D measurements could be important before percutaneous aortic valvuloplasty or surgical replacement.

Comparison of Aortic Annulus Diameter Measurement between Multi-Detector Computed Tomography and Echocardiography: A Meta-Analysis

Background and PurposeAccurate measurement of aortic annulus diameter is crucial for choosing suitable prosthetic size for transcatheter aortic valve implantation (TAVI). Several imaging methods are available for the measurement, but significant variability between different modalities has been observed. The purpose of this study was to systematically compare the measurements of aortic annulus diameter between multi-detector computed tomography (MDCT), transthoracic echocardiography (TTE), and transesophegeal echocardiography (TEE).MethodsPubMed and EMBASE databases between January 2000 and January 2012 were searched. We extracted data from eligible studies evaluating the aortic annulus diameter by MDCT and echocardiography (TTE, TEE, or both). We performed a random-effects meta-analysis to calculate the weighted mean differences of aortic annulus diameter measurement between MDCT, TTE, and TEE.ResultsA total of 10 eligible studies involving 581 subjects with aortic valve stenosis were included. Aortic annulus diameter measured on coronal view by MDCT (25.3±0.52 mm) was respectively larger than that measured on sagittal view by MDCT (22.7±0.37 mm), TTE (22.6±0.28 mm), and TEE (23.1±0.32 mm). The weighted mean difference of aortic annulus diameter between coronal view by MDCT and TTE these two methods was 2.97 mm, followed by the weighted mean difference of 2.53 mm between coronal view and sagittal view by MDCT, and the mean difference of 1.74 mm between coronal view on MDCT and TEE (P<0.0001 for all). The weighted mean difference of aortic annulus diameter measurement between TEE and TTE was significant but somewhat small (0.45 mm, P = 0.007).ConclusionAortic annulus diameter measured on coronal view by MDCT was robustly and significantly larger than that obtained on sagittal view by MDCT, TTE, or TEE. Such variability of aortic annulus diameter measurement by different imaging modalities cannot be ignored when developing optimal strategies for selection of prosthetic valve size in TAVI.

269: Comparison of 2D and 3D transthoracic echocardiography for measurement of aortic annulus diameter in a paediatric population

Precise evaluation of the aortic root geometry is necessary in congenital aortic valve lesions in children, to optimize surgical or percutaneous procedures. The aim of the study was to compare two-dimensional (2D-TTE) and three-dimensional transthoracic echocardiography (3D-TTE) for analysis of aortic annulus and assess feasibility of 3D imaging. Thirty consecutive children, without heart disease, aged 11± 3.6 years old (min 4; max 18; 66.7% boys), were prospectively included in this study. Transthoracic real time 2D and 3D echocardiography (ie 33, Philips, Andover MA, US) was performed using matrix probe (x 3-1, x 7-2 and x 5-1). Multiplanar reconstruction was used to measure in diastole two orthogonal aortic annulus diameters, compared to the measurement in a parasternal long axis view in 2D-TTE. 3D aortic annulus diameters measurements were obtained in 28 (93.3%) children. Mean annulus diameter in 2D TTE (1.93±0.2 cm) was not significantly different of the mean minimal diameter (1.95 cm± 0.3, p=0.43) but was smaller than the mean maximal diameter (2.03 cm ±0.3, p=0.002) in 3D-TTE. 2D annulus diameter was well correlated to minimal 3D diameter (r=0.89, p<0.0001) and maximal diameter (r=0.88, p<0.0001). A significant difference in the mean minimal and maximal 3D aortic annulus diameters was observed (p<0.0001). 3D horizontal aortic annulus diameter was larger in 15 patients (54%) whereas vertical diameter was larger in 7 patients (25%). Orthogonal diameters were equal in 6 patients (21%). The index of eccentricity was 4±3%. This preliminary study demonstrated the feasibility of 3D-TTE for the assessment of aortic annulus diameter in a standard children population. Because of the asymmetry of the aortic annulus, such 3D measurements could have important issues before aortic valve dilatation or surgical replacement in children.

Aortic Annulus Diameter Measurement: What Is the Best Modality?

The purpose of this study was to clarify the most suitable method to measure the aortic annulus diameter. Fifty-five patients, who had undergone aortic valve replacement at Miyazaki University Hospital between April 2008 and May 2011, were included in this study. The maximum diameter of the sizing tool that could be inserted into the left ventricle through the annulus had been predicted, based on the diameter measured by each modality. Agreement with surgery and each imaging modality, namely transthoracic echocardiography, multidetector computed tomography and contrast angiography, were compared using Bland-Altman analysis. The predicted aortic annulus diameter, based on the diameter measured by transthoracic echocardiography, multidetector computed tomography and contrast angiography, was 20.3 ± 2.50, 23.9 ± 3.19, and 23.5 ± 3.55 mm, respectively, whereas, the diameter measured at surgery was 23.7 ± 2.99 mm. Predicted aortic annulus diameter measured by multidetector computed tomography best agreed with that measured at surgery. We conclude that the aortic annulus diameter, measured by multidetector computed tomography, is the best modality to measure the aortic annulus diameter.

Patient selection—risk assessment and anatomical selection criteria for patients undergoing transfemoral aortic valve implantation

Currently percutaneous aortic valve replacement (PAVR) is indicated for patients at high surgical risk or for inoperable patients. Preprocedural evaluation is crucial to select the patients who will benefit the most and have the procedure done safely. This review will focus on risk assessment and the value of the available risk score systems, and on the screening process, which is the key for success in PAVR. Because of the large delivery system, careful evaluation of iliofemoral vessels is crucial. It is important to know the amount of atherosclerosis and plaque in the aortic arch and ascending aorta for potential risk for neurological events. Accurate measurement of aortic annulus diameter and coronary arteries origin before the procedure is important. Specific coexistent conditions can influence the procedure, such as left ventricular function or left ventricular hypertrophy with narrow outflow tract. Assessment of all these components is necessary for procedural planning of access approach, valve sizing, and deployment.

Study on measurement of aortic annulus diameter by real-time three-dimensional transesophageal echocardiography

Objective To research the feasibility and accuracy on echocardiography measurement aortic annulus diameter(AAD)at the plane of three Junctions of aortic valve leaflets by real-time three-dimensional transesophageal echocardiography(RT-3D-TEE).Methods Twenty-three patients underwent echocardiography and aortic valve replacement because of acquired aortic valve disease.The AAD was measured in parasternal left ventricle long axis view(TTE-AAD)by transthoracic echocardiography(TTE)preoperative.The AAD was measured in left ventricle long axis view(TEE-AAD)and the distance of three iunctions of aortic valve leaflets (N,L,R) was measured in aortic short axis view by RT-3D-TEE intraoperative.The three-dimensional full volume images were analyzed by online QLAB 7.0 software.The AAD was measured by standard cylindrical valve sizer (OP-AAD)before aortic valve replacement surgery,too.Results Comparing with the three aortic valve leaflets of acquired aortic valve disease,the lines between their junctions constituted an approximate equilateral triangle regardless of the cause and degree of disease,and the length of the three groups was no significant difference(P>0.05).There was no significant difference between TTE-AAD and OP-AAD group(P>0.05),and the correlation was good(r=0.84).The N,L and R group compared separately with the OP-AAD group, there was no significant difference(P>0.05)and correlation was superior to TTE-AAD group(r=0.94, 0.97, 0.96).The difference between TEE-AAD and OP-AAD were significant(P<0.01).Conclusions Echocardiography measurement of AAD at the plane of three junctions of aortic valve leaflets is feasible,and it is better accuracy and repeatability comparing with parasternal left ventricle long axis view. Key words: Echocardiography,real-time three-dimensional; Echocardiography, transeophageal; Aortic valve