A comparative analysis of left ventriculography and root aortography for estimating aortic annular size

This study was undertaken to compare the usefulness of left ventriculography versus root aortography as a means of assessing the aortic annular size in 75 patients with a narrow aortic anulus. These patients were divided into two groups: Group I consisted of 57 patients undergoing standard aortic valve replacement with a 21 mm prosthesis and Group II consisted of 18 patients undergoing modified aortic valve replacement with the aid of an anulus-enlarging procedure or an apico-aortic conduit. In Group I, left ventriculography gave 23.2 +/- 1.8 mm (mean +/- standard deviation), whereas the aortography method showed 22.4 +/- 2.7 mm (p less than 0.05). Those values of 20 mm or less were regarded as imperfect measurements; inaccurate results were more frequent in the aortography method (16 cases; 28%) than in the left ventriculography method (only two cases; 3.5%), with significant difference (p less than 0.025%). In Group II, there was no significant difference in respective values determined by the two different methods; 18.7 +/- 3.0 mm, with a range from 13 to 23 mm in the left ventriculography method, and 19.9 +/- 3.1 mm, with a range from 14 to 24 mm, in the aortography method (p greater than 0.2). Imperfect measurement by the aortography method tended to occur when the cusp base was severely deformed. The results indicated that left ventriculography was more reliable than root aortography for estimating the size of the aortic anulus.