The Journal of Thoracic and Cardiovascular Surgery, Vol 81, 451-454, Copyright © 1981 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Predicting aortic valve prosthesis size. A step toward better matching of patient and prosthesis
JD Babb, GV Parr and MJ O'Neill Jr
We have developed a simple method of predicting aortic valve prosthesis
size from supravalvular aortic cineangiograms, taken in the 30 degree right
anterior oblique projection, during routine diagnostic cardiac
catheterization. Measurements made on the aortogram were corrected to true
size by means of a 1 cm2 grid reference plate filmed at the conclusion of
the catheterization. This method was utilized prospectively to predict the
anulus size in 26 patients undergoing aortic valve replacement alone or as
part of a more extensive procedure. The catheterization prediction of
anulus size was perfectly predictive of the prosthesis size used in eight
of 26 (31%) cases, within 1 mm of the prosthesis size used in 20 of 26
(77%), and within one prosthesis size in all 26 (100%) cases. Comparing the
measured anulus diameter to the actual prosthesis diameter yielded r =
0.93. When both systolic and diastolic frames were available for analysis,
the diastolic frame was more accurately predictive than the systolic frame
(diastolic r = 0.93; systolic r = 0.88), although both yielded acceptable
results. Utilization of this method has significantly altered operative
plans in four patients with a small anulus. Such preoperative assessment
should allow improved matching of patient and valve prosthesis and thereby
yield improved long-term results in aortic valve replacement.
