Preoperative Aortic valve Sizing. Is TTE enough? A case series of 54 cases of AVR performed in MCCCS

Abstract

Introduction; aortic valve replacement is a common wide spread surgical procedure performed
worldwide. One of the main problems in such procedure is facing a small aortic ring to which the
surgeon may not have a suitable size valve. So all efforts are made to try to measure the aortic ring
preoperatively by different methods like transthoracic echocardiography, transesophageal
echocardiography, CT scan and others
Objectives; the main objective of this study is to assess the ability of transthoracic echocardiography in
successfully measuring the aortic ring in Mosul Center for Cardiology and Cardiac Surgery and
comparing it with other measurement methods.
Methods; this is a retrospective clinical case series study conducted in Mosul Center for Cardiology
and Cardiac Surgery over the period from June 2012 to February 2014. 54 patients were included in the
study and were studied according to their sex and age distribution, type and cause of aortic valve
disease, aortic valve morphology, echocardiographic and intraoperative aortic ring sizing.
Results; 48.1% of our patients had an echocardiographic and intraoperative aortic valve measurement
within 1 mm difference while 28.8% had an echocardiographic aortic ring being 1-2.5 mm larger than
the intraoperative aortic ring measurement and 23.1% had the echocardiographic measurements being
more than 2.5 mm larger than the actual intraoperative size.
Discussion: these results were found to be comparable to other international results and also
comparable to other studies that used other preoperative measurement methods
Conclusion; transthoracic echocardiographic measurement of the aortic ring is a safe, non-invasive and
reliable method for measuring the aortic ring without the need for other invasive and expensive
procedures however the surgeon should prepare at least one valve size smaller than the
echocardiographic measured aortic ring for safety.