title: Three dimensional evaluation of the aortic annulus using multislice computer tomography: are manufacturer's guidelines for sizing for percutaneous aortic valve replacement helpful?
abstract: OBJECTIVE
  To evaluate the effects of applying current sizing guidelines to different multislice computer tomography (MSCT) aortic annulus measurements on Corevalve (CRS) size selection.
  
  
  RESULTS
  Multislice computer tomography annulus diameters [minimum: D(min); maximum: D(max); mean: D(mean) = (D(min) + D(max))/2; mean from circumference: D(circ); mean from surface area: D(CSA)] were measured in 75 patients referred for percutaneous valve replacement. Fifty patients subsequently received a CRS (26 mm: n = 22; 29 mm: n = 28). D(min) and D(max) differed substantially [mean difference (95% CI) = 6.5 mm (5.7-7.2), P < 0.001]. If D(min) were used for sizing 26% of 75 patients would be ineligible (annulus too small in 23%, too large in 3%), 48% would receive a 26 mm and 12% a 29 mm CRS. If D(max) were used, 39% would be ineligible (all annuli too large), 4% would receive a 26 mm, and 52% a 29 mm CRS. Using D(mean), D(circ), or D(CSA) most patients would receive a 29 mm CRS and 11, 16, and 9% would be ineligible. In 50 patients who received a CRS operator choice corresponded best with sizing based on D(CSA) and D(mean) (76%, 74%), but undersizing occurred in 20 and 22% of which half were ineligible (annulus too large).
  
  
  CONCLUSIONS
  Eligibility varied substantially depending on the sizing criterion. In clinical practice both under- and oversizing were common. Industry guidelines should recognize the oval shape of the aortic annulus.
authors.affiliation: Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Schultz
authors.forename: Adriaan
authors.initials: A
authors.lastname: Moelker
authors.forename: Nicolo
authors.initials: N
authors.lastname: Piazza
authors.forename: Apostolos
authors.initials: A
authors.lastname: Tzikas
authors.forename: Amber
authors.initials: A
authors.lastname: Otten
authors.forename: Rutger J
authors.initials: RJ
authors.lastname: Nuis
authors.forename: Lisan A
authors.initials: LA
authors.lastname: Neefjes
authors.forename: Robert J
authors.initials: RJ
authors.lastname: van Geuns
authors.forename: Pim
authors.initials: P
authors.lastname: de Feyter
authors.forename: Gabriel
authors.initials: G
authors.lastname: Krestin
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.forename: Peter P T
authors.initials: PP
authors.lastname: de Jaegere
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000473:pathology; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D019981:Health Care Sector; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D009929:Organ Size; D017410:Practice Guidelines as Topic; D011474:Prosthesis Design; D017755:Prosthesis Fitting / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods*