title: Erroneous measurement of the aortic annular diameter using 2-dimensional echocardiography resulting in inappropriate CoreValve size selection: a retrospective comparison with multislice computed tomography.
abstract: OBJECTIVE
  This study sought to assess the differential adherence to transcatheter heart valve (THV)-oversizing principles between transesophageal echocardiography (TEE) and multislice computed tomography (CT) and its impact on the incidence of paravalvular leak (PVL).
  
  
  BACKGROUND
  CT has emerged as an alternative to 2-dimensional TEE for THV sizing.
  
  
  METHODS
  In our early experience, TEE-derived aortic annular diameters determined THV size selection. CT datasets originally obtained for vascular screening were retrospectively interrogated to determine CT-derived annular diameters. Annular dimensions and expected THV oversizing were compared between TEE and CT. The incidence of PVL was correlated to TEE- and CT-based oversizing calculations.
  
  
  RESULTS
  Using TEE-derived annulus measurements, 157 patients underwent CoreValve implantation (23 mm: n = 66; 29 mm: n = 91). The estimated THV oversizing on the basis of TEE was 20.1 ± 8.2%. Retrospective CT analysis yielded larger annular diameters than TEE (p < 0.0001). When these CT diameters were used to recalculate the percentage of oversizing achieved with the TEE-selected CoreValve, the actual THV oversizing was only 10.4 ± 7.8%. Consequently, CT analysis suggested that up to 50% of patients received an inappropriate CoreValve size. When CT-based sizing criteria were satisfied, the incidence of PVL was 21% lower than that with echocardiography (14% vs. 35%; p = 0.003). Adherence to CT-based oversizing was independently associated with a reduced incidence of PVL (odds ratio 0.36; 95% confidence interval: 0.14 to 0.90; p = 0.029); adherence to TEE-based sizing was not.
  
  
  CONCLUSIONS
  Retrospective CT-based annular analysis revealed that CoreValve size selection by TEE was incorrect in 50% of patients. The percentage of oversizing with CT was one-half of that calculated with TEE resulting in the majority of patients receiving a THV that was too small.
authors.affiliation: Department of Interventional Cardiology, McGill University Health Centre, Montreal, Quebec, Canada; Department of Cardiology, University Hospital Galway, Galway, Ireland.
authors.forename: Darren
authors.initials: D
authors.lastname: Mylotte
authors.affiliation: Department of Cardiovascular Surgery, German Heart Centre Munich, Munich, Germany.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Dorfmeister
authors.affiliation: Department of Cardiovascular Surgery, German Heart Centre Munich, Munich, Germany.
authors.forename: Yacine
authors.initials: Y
authors.lastname: Elhmidi
authors.affiliation: Department of Cardiovascular Surgery, German Heart Centre Munich, Munich, Germany.
authors.forename: Domenico
authors.initials: D
authors.lastname: Mazzitelli
authors.affiliation: Department of Cardiovascular Surgery, German Heart Centre Munich, Munich, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Bleiziffer
authors.affiliation: Department of Cardiovascular Surgery, German Heart Centre Munich, Munich, Germany.
authors.forename: Anke
authors.initials: A
authors.lastname: Wagner
authors.affiliation: Department of Cardiovascular Surgery, German Heart Centre Munich, Munich, Germany.
authors.forename: Timothee
authors.initials: T
authors.lastname: Noterdaeme
authors.affiliation: Department of Cardiovascular Surgery, German Heart Centre Munich, Munich, Germany.
authors.forename: Ruediger
authors.initials: R
authors.lastname: Lange
authors.affiliation: Department of Interventional Cardiology, McGill University Health Centre, Montreal, Quebec, Canada; Department of Cardiovascular Surgery, German Heart Centre Munich, Munich, Germany. Electronic address: nicolopiazza@mac.com.
authors.forename: Nicolo
authors.initials: N
authors.lastname: Piazza
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography / Q000379:methods*; D011474:Prosthesis Design; D015203:Reproducibility of Results; D012189:Retrospective Studies
keywords: aortic stenosis; computed tomography; transcatheter aortic valve replacement; transcatheter heart valve; transesophageal echocardiography