title: Remodelling of the aortic root in severe tricuspid aortic stenosis: implications for transcatheter aortic valve implantation.
abstract: Detailed knowledge of aortic root geometry is a prerequisite to anticipate complications of transcatheter aortic valve (TAV) implantation. We determined coronary ostial locations and aortic root dimensions in patients with aortic stenosis (AS) and compared these values with normal subjects using computed tomography (CT). One hundred consecutive patients with severe tricuspid AS and 100 consecutive patients without valvular pathology (referred to as the controls) undergoing cardiac dual-source CT were included. Distances from the aortic annulus (AA) to the left coronary ostium (LCO), right coronary ostium (RCO), the height of the left coronary sinus (HLS), right coronary sinus (HRS), and aortic root dimensions [diameters of AA, sinus of Valsalva (SV), and sino-tubular junction (STJ)] were measured. LCO and RCO were 14.9 +/- 3.2 mm (8.2-25.9) and 16.8 +/- 3.6 mm (12.0-25.7) in the controls, 15.5 +/- 2.9 mm (8.8-24.3) and 17.3 +/- 3.6 mm (7.3-26.0) in patients with AS. Controls and patients with AS had similar values for LCO (P = 0.18), RCO (P = 0.33) and HLS (P = 0.88), whereas HRS (P < 0.05) was significantly larger in patients with AS. AA (r = 0.55,P < 0.001), SV (r = 0.54,P < 0.001), and STJ (r = 0.52,P < 0.001) significantly correlated with the body surface area in the controls; whereas no correlation was found in patients with AS. Patients with AS had significantly larger AA (P < 0.01) and STJ (P < 0.01) diameters when compared with the controls. In patients with severe tricuspid AS, coronary ostial locations were similar to the controls, but a transverse remodelling of the aortic root was recognized. Owing to the large distribution of ostial locations and the dilatation of the aortic root, CT is recommended before TAV implantation in each patient.
authors.affiliation: Institute of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
authors.forename: Paul
authors.initials: P
authors.lastname: Stolzmann
authors.forename: Joseph
authors.initials: J
authors.lastname: Knight
authors.forename: Lotus
authors.initials: L
authors.lastname: Desbiolles
authors.forename: Willibald
authors.initials: W
authors.lastname: Maier
authors.forename: Hans
authors.initials: H
authors.lastname: Scheffel
authors.forename: André
authors.initials: A
authors.lastname: Plass
authors.forename: Vartan
authors.initials: V
authors.lastname: Kurtcuoglu
authors.forename: Sebastian
authors.initials: S
authors.lastname: Leschka
authors.forename: Dimos
authors.initials: D
authors.lastname: Poulikakos
authors.forename: Borut
authors.initials: B
authors.lastname: Marincek
authors.forename: Hatem
authors.initials: H
authors.lastname: Alkadhi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D001027:Aortography / Q000379:methods*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014261:Tricuspid Valve / Q000000981:diagnostic imaging* / Q000601:surgery*