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J Thorac Cardiovasc Surg 1997;114:146
© 1997 Mosby, Inc.

LETTERS TO THE EDITOR

Measurement of aortic diameter

Imperial College School of Medicine
Department of Paediatrics
National Heart and Lung Institute
Dovehouse St.
London SW3 6LY, United Kingdom

To the Editor:

In the October 1996 issue of the Journal, Weinert and colleagues ¹ give an elegant account of their measurements of aortic diameter by means of multiplane transesophageal echocardiography. I have no complaints whatsoever concerning the excellence of the techniques described, but I have major problems with the anatomic structures that are purported to be measured. Apart from the fact that there is no ringlike structure ³ supporting the hingepoints of the aortic valve leaflets (the so-called "anulus"), if the Chicago group makes measurements as they claim, then it is impossible for them to quantify the fullest diameter of the aortic root. The reason, of course, is that the aortic valve possesses three sinuses and leaflets and, even though the sinuses are rarely completely equal, ⁴ measuring from the basal attachment of the noncoronary leaflet to the basal attachment of the right coronary leaflet will always produce a chord of the outflow tract. Calculations on the basis of the aortic root being a circle shows that measurements of the kind proposed underestimate the true diameter by a factor of 10% or more. The aortic root, of course, is not a true circle, but these geometric considerations are surely worthy of at least some discussion in studies of this kind.

References

1. Weinert L, Karp R, Vignon P, Bales A, Lang RM. Feasibility of aortic diameter measurement by multiplane transesophageal echocardiography for preoperative selection and preparation of homograft aortic valves. J Thorac Cardiovasc Surg 1996;112:954-61.[Abstract/Free Full Text]
   
2. Anderson RH, Devine WA, Ho SY, Smith A, McKay R. The myth of the aortic annulus: the anatomy of the subaortic outflow tract. Ann Thorac Surg 1991;52:640-6.[Abstract]
   
3. Sutton JP III, Ho SY, Anderson RH. The forgotten interleaflet triangles: a review of the surgical anatomy of the aortic valve. Ann Thorac Surg 1995;59:419-27.[Abstract/Free Full Text]
   
4. Vollebergh FEMG, Becker AE. Minor congenital variations of cusp size in tricuspid aortic valves: possible link with aortic stenosis. Br Heart J 1977;39:1006-11.[Abstract/Free Full Text]
   

This article has been cited by other articles:

				N. Piazza, P. de Jaegere, C. Schultz, A. E. Becker, P. W. Serruys, and R. H. Anderson Anatomy of the Aortic Valvar Complex and Its Implications for Transcatheter Implantation of the Aortic Valve Circ Cardiovasc Interv, August 1, 2008; 1(1): 74 - 81. [Abstract] [Full Text] [PDF]

This Article Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Robert H. Anderson Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Anderson, R. H. Search for Related Content PubMed PubMed Citation Articles by Anderson, R. H.