• Aidan Sharkey, Adnan A Khan, Rayaan Yunus, Taha Rehman, Yifan Bu, Shirin Saeed, Robina Matyal, and Feroze Mahmood.
• Department of Anesthesia, Critical Care and Pain Medicine Department, Beth Israel Deaconess Medical Center, Boston, MA. Electronic address: asharkey@bidmc.harvard.edu.
• J. Cardiothorac. Vasc. Anesth. 2024 Jul 1; 38 (7): 146014661460-1466.

ObjectivesThis study aimed to evaluate the accuracy of identifying the true aortic valve (AV) annulus using 2-dimensional (2D) echocardiography, with the goal of highlighting potential misidentification issues in clinical practice.DesignAn observational study employing 3-dimensional (3D) datasets to generate 2D images of the AV annulus for analysis.SettingThe study was conducted in an academic medical center.ParticipantsThree-dimensional transesophageal echocardiography datasets were obtained from 11 patients with normal AV and aortic root anatomies undergoing coronary artery bypass surgery. Attending anesthesiologists certified by the National Board of Echocardiography (NBE) were approached subsequently to participate in this study.InterventionsTwo images per patient were generated from 3D datasets, reflecting the mid-esophageal long-axis view of the AV, a true AV annulus image, and an off-axis image. A survey was distributed to NBE-certified perioperative echocardiographers across 12 academic institutions to identify the true AV annulus from these images.Measurements And Main ResultsThe survey, completed by 45 qualified respondents, revealed a significant misidentification rate of the true AV annulus, with only 36.8% of responses correctly identifying it. The rate of correct identification varied across image sets, with 44.4% of participants unable to correctly identify any true AV annulus image.ConclusionsThe study highlighted the limitations of 2D echocardiography in accurately identifying the true AV annulus in complex 3D structures like the aortic root. The findings suggest a need for greater reliance on advanced imaging modalities, such as 3D echocardiography, to improve accuracy in clinical practice.Copyright © 2024 Elsevier Inc. All rights reserved.

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