Three dimensional evaluation of the aortic annulus using multislice computer tomography: are manufacturer's guidelines for sizing for percutaneous aortic valve replacement helpful?
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.
Schultz
Carl J
CJ
Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.
Moelker
Adriaan
A
Piazza
Nicolo
N
Tzikas
Apostolos
A
Otten
Amber
A
Nuis
Rutger J
RJ
Neefjes
Lisan A
LA
van Geuns
Robert J
RJ
de Feyter
Pim
P
Krestin
Gabriel
G
Serruys
Patrick W
PW
de Jaegere
Peter P T
PP
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*