King's College London

Research portal

Correlation of Echocardiographic and Angiographic Measurements of the Pulmonary Valve Annulus in Pulmonary Stenosis

Research output: Contribution to journalArticle

Original languageEnglish
Pages (from-to)192-196
Number of pages5
JournalCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS
Volume84
Issue number2
DOIs
Publication statusPublished - 1 Aug 2014

King's Authors

Abstract

Objectives: The pulmonary valve (PV) annulus is routinely measured angiographically in PV stenosis prior to balloon dilation. We sought to establish whether this radiation exposure is justified, or whether echocardiographic measurements prior to the procedure are sufficient to guide balloon selection. 

Background: Previous studies have found a strong correlation between echocardiographic and angiographic measurements of the PV annulus. However, error of measurement and its implication for procedural practice has not been explored. 

Methods: A total of 90 procedures in 84 patients were analyzed, at a median age 7.6 months (range 1 day to 14.2 years). The contemporaneous echocardiographic and angiographic measurements were recorded, and the original echocardiograms were re-measured in the 72 available cases by two independent reviewers. 

Results: There was a good correlation between the two measurement methods (R-2=0.87). However, the echocardiographic PV measurements were smaller on average, with a significant variation in that discrepancy (mean ratio 0.941 (+/- 0.16)). There was no significant reduction in error if extreme measurements (PV annulus z-score <-3) were excluded (P=0.09), or if the reviewed echocardiographic measurements were used (P=0.58). 

Conclusions: There is an unacceptable discrepancy between the measurement techniques: 95% of patients are predicted to have an echocardiographic measurement error between -37% and +26%. Therefore, there is no correction factor that could be employed to allow safe selection of balloon size, and balloon pulmonary valvoplasty without angiographic PV measurement cannot be advocated.

View graph of relations

© 2018 King's College London | Strand | London WC2R 2LS | England | United Kingdom | Tel +44 (0)20 7836 5454