Determinants of the degree of functional aortic regurgitation in patients with anatomically normal aortic valve and ascending thoracic aorta aneurysm. Transoesophageal Doppler echocardiography study.
OBJECTIVE
To identify functional aortic regurgitation (FAR) determinants in patients with ascending thoracic aortic aneurysm (ATAA) and surgically confirmed normal aortic valve anatomy.


METHODS
Case-control study.


METHODS
Non-invasive Cardiology and Cardiac Surgery Department.


METHODS
Eighty-nine patients with ATAA and varying degrees of FAR undergoing surgery, 40 age-matched patients with ATAA without aortic regurgitation and 20 normal control subjects.


METHODS
Doppler and two-dimensional transoesophageal echocardiography.


METHODS
Vena contracta (VC) of aortic regurgitant jet, diastolic tented area and coaptation height (CH) of aortic valve leaflets, aortic dimension indexes-Valsalva sinus, sinotubular junction (STJ), tubular tract, annulus (A), STJ/A ratio.


RESULTS
When VC was used, a wide range of FAR was seen (mean (SD) 5.59 (2.59) mm, ranging from 2 to 13 mm). Of the variables tested, the most strongly associated with FAR severity in multivariate analysis was diastolic leaflet tenting, measured as CH (R(2) = 0.69) (sensitivity 98%, specificity 95% using a cut-off value of CH > or =1.1 cm). In turn, the diastolic leaflet tenting was strongly identified by the STJ/A ratio (sensitivity 87%, specificity 71% using a cut-off value of STJ/A >1.66).


CONCLUSIONS
The diastolic tenting of aortic leaflets is strongly related to FAR severity in patients with ATAA. The mismatch of STJ/A is significantly associated with diastolic leaflet tenting and its correlated valve regurgitation, independently of the actual ATAA dimension. These findings provide new insight into the mechanism of FAR arising from ATAA.
La Canna
G
G
Echocardiography Unit, San Raffaele Hospital, Milan, Italy. lacanna.giovanni@hsr.it
Maisano
F
F
De Michele
L
L
Grimaldi
A
A
Grassi
F
F
Capritti
E
E
De Bonis
M
M
Alfieri
O
O
D000328:Adult; D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D001021:Aortic Valve / Q000502:physiology* / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D003971:Diastole; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged