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Feasibility of aortic diameter measurement by multiplane transesophageal echocardiography for preoperative selection and preparation of homograft aortic.

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Presentation on theme: "Feasibility of aortic diameter measurement by multiplane transesophageal echocardiography for preoperative selection and preparation of homograft aortic."— Presentation transcript:

1 Feasibility of aortic diameter measurement by multiplane transesophageal echocardiography for preoperative selection and preparation of homograft aortic valves  Lynn Weinert, BS, Robert Karp, MD, Philippe Vignon, MD, Amy Bales, MD, Roberto M. Lang, MD  The Journal of Thoracic and Cardiovascular Surgery  Volume 112, Issue 4, Pages (October 1996) DOI: /S (96) Copyright © 1996 Mosby, Inc. Terms and Conditions

2 Fig. 1 TEE still frame obtained with a multiplane probe (longitudinal plane) from a patient with a normal trileaflet aortic valve. It demonstrates proper alignment of the aortic root and sinuses of Valsalva. Arrows depict placement of calipers for correct aortic annular measurement. The measurement was obtained in early systole, at the time of maximal leaflet excursion. LA, Left atrium; LV, left ventricle; RV, right ventricle; NCC, noncoronary aortic cusp; RCC, right coronary aortic cusp. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (96) ) Copyright © 1996 Mosby, Inc. Terms and Conditions

3 Fig. 2 Bland-Altman plot demonstrating the agreement between aortic annular measurements obtained by the first experienced reader (prospective study) by combined TTE and TEE approaches and the measurements obtained at the time of operation with a ring valve sizer. The 0 line (solid line) corresponds to the line of perfect agreement. The middle dashed line represents the mean difference. Upper and lower dashed lines correspond, respectively, to the upper and lower limits of agreement. SD, Standard deviation. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (96) ) Copyright © 1996 Mosby, Inc. Terms and Conditions

4 Fig. 3 Bland-Altman plot demonstrating the agreement between aortic annular measurements obtained by the second experienced reader (retrospective study) by TTE or TEE and measurements obtained at the time of operation with a ring valve sizer. The 0 line (solid line) corresponds to the line of perfect agreement. The middle dashed line represents the mean difference. Upper and lower dashed lines correspond, respectively, to the upper and lower limits of agreement. SD, Standard deviation. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (96) ) Copyright © 1996 Mosby, Inc. Terms and Conditions

5 Fig. 3 Bland-Altman plot demonstrating the agreement between aortic annular measurements obtained by the second experienced reader (retrospective study) by TTE or TEE and measurements obtained at the time of operation with a ring valve sizer. The 0 line (solid line) corresponds to the line of perfect agreement. The middle dashed line represents the mean difference. Upper and lower dashed lines correspond, respectively, to the upper and lower limits of agreement. SD, Standard deviation. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (96) ) Copyright © 1996 Mosby, Inc. Terms and Conditions

6 Fig. 4 Bland-Altman plot demonstrating the agreement between aortic annular measurements obtained by the intermediate reader by TTE or TEE and measurements obtained at the time of operation with a ring valve sizer. The 0 line (solid line) corresponds to the line of perfect agreement. The middle dashed line represents the mean difference. Upper and lower dashed lines correspond, respectively, to the upper and lower limits of agreement. SD, Standard deviation. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (96) ) Copyright © 1996 Mosby, Inc. Terms and Conditions

7 Fig. 4 Bland-Altman plot demonstrating the agreement between aortic annular measurements obtained by the intermediate reader by TTE or TEE and measurements obtained at the time of operation with a ring valve sizer. The 0 line (solid line) corresponds to the line of perfect agreement. The middle dashed line represents the mean difference. Upper and lower dashed lines correspond, respectively, to the upper and lower limits of agreement. SD, Standard deviation. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (96) ) Copyright © 1996 Mosby, Inc. Terms and Conditions

8 Fig. 5 Bland-Altman plot demonstrating the agreement between aortic annular measurements obtained by the inexperienced reader by TTE or TEE and measurements obtained at the time of operation with a ring valve sizer. The 0 line (solid line) corresponds to the line of perfect agreement. The middle dashed line represents the mean difference. Upper and lower dashed lines correspond, respectively, to the upper and lower limits of agreement. SD, Standard deviation. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (96) ) Copyright © 1996 Mosby, Inc. Terms and Conditions

9 Fig. 5 Bland-Altman plot demonstrating the agreement between aortic annular measurements obtained by the inexperienced reader by TTE or TEE and measurements obtained at the time of operation with a ring valve sizer. The 0 line (solid line) corresponds to the line of perfect agreement. The middle dashed line represents the mean difference. Upper and lower dashed lines correspond, respectively, to the upper and lower limits of agreement. SD, Standard deviation. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (96) ) Copyright © 1996 Mosby, Inc. Terms and Conditions

10 Fig. 6 Still frames (longitudinal views) obtained from a patient with a torn noncoronary aortic cusp diagnosed with the use of TEE. A, Improper alignment of the sinuses of Valsalva, which resulted in an erroneously large annular measurement of 27 mm. B, Still frame (longitudinal view) obtained from the same patient after realignment of the sinuses of Valsalva and aortic root. Proper positioning enabled accurate determination of the aortic annular size (23 mm), which was confirmed at the time of operation. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (96) ) Copyright © 1996 Mosby, Inc. Terms and Conditions

11 Fig. 7 Still frames (longitudinal views) obtained from two patients with bicuspid aortic valves and dilated aortic roots with the use of multiplane TEE. A, This patient had predominant aortic regurgitation. Notice the symmetry of the sinuses of Valsalva, with an annular diameter size of 30 mm. B, In this patient with aortic stenosis, there was marked asymmetry of the sinuses of Valsalva, with an annular diameter of 25 mm. Frequent scanning from the short to the long axis clearly identified the correct leaflet insertion sites into the aortic root. RV, Right ventricle; LA, left atrium; AO ROOT, aortic root. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (96) ) Copyright © 1996 Mosby, Inc. Terms and Conditions

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