Prediction of homograft aortic valve size by transthoracic and transesophageal two-dimensional echocardiography

To avoid the problem of patient valve mismatch we assessed the reliability of echocardiographic measurements in selecting an appropriate-sized homograft aortic valve. Preoperative transthoracic echocardiography (TTE) was performed in 26 consecutive patients undergoing aortic value replacement with a cryopreserved human homograft; 19 of the patients also had intraoperative transesophageal echocardiography (TTE). The diameters of Left ventricular outflow tract (LVOT), aortic annulus, sinuses of Valsalva, and ascending aorta were measured by the same technique in all patients. There was a strong correlation between LVOT diameter measured by intraoperative TEE and homograft aortic valve size selected by the surgeon (r = 0.91, P < 0.001). A good correlation was also found between LVOT measured by preoperative TTE and the homograft valve size (r = 0.82, P = 0.001). The correlation between the homograft aortic valve size and the diameter of aortic annulus was less optimal; the correlation was poor for the diameter of aorta measured at the level of the sinuses of Valsalva and ascending aorta. Measurement of the LVOT diameter by intraoperative TEE and preoperative TTE is reliable and clinically useful for the preparation. of homograft aortic valves and selection of proper size, particularly in those patients undergoing repeat aortic valve replacement, with heavily calcified aortic valve or with ascending aortic aneurysm.