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Aortic root changes before and after surgery for chronic aortic dilatation: A 3D echocardiographic study
Author(s) -
Ballocca Flavia,
Ruggeri Giulia Maria,
Roscoe Andrew,
Thampinathan Babitha,
David Tirone Esperidiao,
Lang Roberto M.,
Meineri Massimiliano,
Tsang Wendy
Publication year - 2019
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.14216
Subject(s) - medicine , aortic root , aortic valve , cardiology , aortic valve repair , regurgitation (circulation) , cusp (singularity) , surgery , aorta , geometry , mathematics
Background Quantitative 3D assessment of the aortic root may improve planning and success of aortic valve ( AV )‐sparing operations. Aims To use 3D transesophageal echocardiography ( TEE ) to assess the effect of chronic aortic dilatation on aortic root shape and aortic regurgitation ( AR ) severity and to examine the effects of AV ‐sparing operations. Methods and Results To determine the changes with chronic aortic dilatation, we studied 48 patients, 23 with aortic dilatation (Group 1 ≤ mild AR , n = 13; Group 2 ≥ moderate AR , n = 10) and 25 Controls. To determine the changes in AV ‐sparing operations, a subgroup of 15 patients were examined pre‐ and post surgery. 3D‐ TEE images were analyzed using multiplanar reconstruction ( QLAB , Philips, Philips Medical Systems, Andover, MA, USA) to obtain aortic root areas, diameters, and lengths. We also calculated a novel parameter called total coaptation surface area ( TC oap SA ), which sums the contact surface area of all the AV cusps. Compared to Controls, Groups 1 and 2 had significantly larger aortic root areas, inter‐commissural distances, and cusp heights. Compared to Group 1 and Controls, Group 2 had significantly smaller TC oap SA when adjusted for aortic annular area ( P = 0.001) with shorter coaptation height ( P < 0.001). In patients undergoing AV ‐sparing surgery, TC oap SA was significantly larger post surgery ( P = 0.001) with greater coaptation height ( P < 0.001) and smaller inter‐commissural distances ( P < 0.001). Conclusions The aortic valve is a dynamic structure that remodels in response to aortic dilatation. Successful valve‐sparing surgery corrects these changes. Quantitative modeling of the aortic valve and root could potentially improve the repair to the individual patients and modify outcomes.