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Original article
Comparison of two-dimensional and three-dimensional imaging techniques for measurement of aortic annulus diameters before transcatheter aortic valve implantation
  1. Ertunc Altiok1,
  2. Ralf Koos1,
  3. Jörg Schröder1,
  4. Kathrin Brehmer1,
  5. Sandra Hamada1,
  6. Michael Becker1,
  7. Andreas H Mahnken2,
  8. Mohammad Almalla1,
  9. Guido Dohmen3,
  10. Rüdiger Autschbach3,
  11. Nikolaus Marx1,
  12. Rainer Hoffmann1
  1. 1Department of Cardiology, University Hospital RWTH Aachen, Aachen, Germany
  2. 2Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
  3. 3Department of Cardiothoracic Surgery, University Hospital RWTH Aachen, Aachen, Germany
  1. Correspondence to Rainer Hoffmann, Medical Clinic I, University RWTH Aachen, Pauwelsstrasse 30, 52057 Aachen, Germany; rhoffmann{at}


Aims Different two-dimensional (2D) and three-dimensional (3D) imaging techniques are used for procedure planning and selection of prosthesis size before transcatheter aortic valve implantation. This study sought to compare different 2D and 3D imaging techniques and determine the accuracy of 3D transoesophageal echocardiography (TEE) for accurate analysis of aortic annulus dimensions.

Methods In 49 consecutive patients with severe aortic stenosis undergoing transcatheter aortic valve implantation angiography, 2D transthoracic echocardiography (TTE), 2D and 3D TEE, and dual-source CT (DSCT) were performed to determine aortic annulus diameters. TTE and 2D TEE provided only one diameter of the aortic annulus. Angiography, DSCT and 3D TEE allowed measurement of diameters in sagittal and coronal views. The distance between aortic annulus and left main coronary artery ostium was measured by angiography, DSCT and 3D TEE.

Results Sagittal diameters determined by angiography, TTE, 2D TEE, 3D TEE and DSCT were smaller than coronal diameters determined by angiography, 3D TEE and DSCT. Coronal and sagittal diameters determined by 3D TEE were in high agreement with corresponding measurements by DSCT (23.60±1.89 vs 23.46±2.07 mm and 22.19±1.96 vs 22.27±2.01 mm, respectively; mean±SD). There was a high correlation between DSCT and 3D TEE for the definition of coronal and sagittal aortic annulus diameters (r=0.88, SEE=0.89 mm and r=0.77, SEE=1.26 mm, respectively). Correlation of 3D TEE (13.47±1.67 mm) and DSCT (13.64±1.82 mm) in the analysis of the distance between aortic annulus and left main coronary artery ostium was better (r=0.54, SEE=1.55 mm) than between angiography (14.85±3.84 mm) and DSCT (r=0.35, SEE=1.77 mm).

Conclusions 3D imaging techniques should be used to evaluate aortic annulus diameters, as 2D imaging techniques, providing only a sagittal view, underestimate them. 3D TEE provides measurements of aortic annulus diameters similar to those obtained by DSCT.

  • Aortic stenosis
  • CT
  • echocardiography
  • transcatheter aortic valve implantation
  • CT scanning
  • echocardiography (three-dimensional)
  • percutaneous valve therapy
  • aortic valve disease

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  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the University of Aachen.

  • Provenance and peer review Not commissioned; externally peer reviewed.