Comparison of aortic valve annulus diameter determination through 3-dimensional transesophageal echo with cardiac MDCT and assessment of predictors for annulus sizing.

Objectives: The long-term success of CoreValve stent prosthesis (Medtronic) implantation for severe aortic valve stenosis is limited in determination of correct aortic valve annulus.

Methods: We retrospectively investigated preinterventional cardiac 256-slice computed tomography (cardiac CT) scans and 3-dimensional transesophageal echocardiography (3D TEE) for assessment of aortic valve annulus to (i) compare both methods as well as (ii) to define predictors for annulus sizing.

Results: We investigated 200 consecutive patients with a mean aortic valve annulus (AA) of 24mm and a mean age of 81 years. Primarily we defined mean diameters of AA individually and grouped the different patients according to age, gender, body weight, length, surface area and body mass index. Thereby, we found statistical significant different annulus diameter in age (larger diameter when < 80 years of age), gender (male > femal), and body length (larger diameter when length > 165cm). Secondly, the multivariate analysis demonstrated that the age, the gender and the body length were additionally independent predictors for annulus size.

Conclusion: Our data demonstrate the feasibility of cardiac CT and 3D TEE with no difference in the quality of the aortic valve annulus diameter determination. We describe predictors for annulus size in age, gender and body length. Conclusive, we support patient dependent parameters as age, gender and body length as predictors that must go into selection of CoreValve stent prosthesis size individually prior to implantation procedure.