2.3.1 3D manual TEE aortic annulus measurement
Multiple 3D zoom datasets were acquired and the dataset with the maximal
aortic diameter was used for analysis. We routinely used biplane imaging
from the aortic short axis view to ensure correct alignment of the
orthogonal long axis plane through the maximal diameter. This has been
previously shown to be a robust method of aortic annular measurement
[37]. From our experience we find this easily reproducible. For 3D
manual TEE aortic annulus measurement commercially available 3D software
(Qlab 3DQ V10.1) was used. A multi-planar reconstructive mode was used
to ensure accurate alignment of the aortic annulus. The data set was
scrolled to maximal aortic valve opening in mid-systole and the 2
orthogonal long axis images (Figure 1 , frame B and C) aligned
to open up the left ventricular outflow tract. The transverse plane(Figure 1 , frame A) was then aligned to transect through the
aortic annulus at the insertion point of the aortic valve in both long
axis views. The transverse plane was then used to measure both annulus
area and minimum and maximum diameters.