title: Aortic root and cusp configuration determine aortic valve function.
abstract: OBJECTIVE
  Normalisation of aortic root and cusp configuration is a prerequisite for successful aortic valve repair (AVR). Using transthoracic echocardiography, we studied aortic root dimensions relative to body size in normal subjects and AVR patients.
  
  
  METHODS
  Aortic roots of healthy volunteers (n=130, age 27.9 ± 16.9 years) were examined for aortoventricular (AV), sinus (S), sinutubular-junction diameters (ST) and effective height (height difference between the AV plane and central coaptation point, eH) by transthoracic echocardiography. In 651 patients, after AVR residual aortic valve insufficiency (AI) and eH were determined. The relationships between eH versus root dimensions and eH versus residual AI were analysed by analysis of variance with Bonferroni post hoc testing.
  
  
  RESULTS
  Root dimensions correlated with each other and body size (r=0.74-0.91). In addition, a correlation between AV (r=0.73), sinus diameter (r=0.76), body height (r=0.77), body surface area (r=0.81) and eH was found. After AVR, eH was 9.8 ± 0.9 mm in 235 patients without postoperative AI, 9.4 ± 1.1mm in 370 with mild AI, 7.9 ± 1.4mm in 43 patients with moderate AI and 6 ± 1mm in three patients with severe AI. The difference in means of effective height between the groups was significant (p<0.005). Of 497 AVR patients with an eH ≥ 9 mm, 309 had no or trivial AI, 186 had mild AI and only two had moderate AI.
  
  
  CONCLUSIONS
  Parameters of aortic root dimensions follow a seemingly constant pattern in humans of different sizes. Effective height has a constant relationship to root dimensions and body size. In AVR, normalisation of eH leads to a high probability of normal or near-normal aortic valve function.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Hospitals of Saarland, Kirrbergerstrasse 1, Homburg/Saar, Germany.
authors.forename: Benjamin Oliver
authors.initials: BO
authors.lastname: Bierbach
authors.forename: Diana
authors.initials: D
authors.lastname: Aicher
authors.forename: Omar Abu
authors.initials: OA
authors.lastname: Issa
authors.forename: Hagen
authors.initials: H
authors.lastname: Bomberg
authors.forename: Stefan
authors.initials: S
authors.lastname: Gräber
authors.forename: Petra
authors.initials: P
authors.lastname: Glombitza
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Schäfers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001011:Aorta / Q000033:anatomy & histology / Q000473:pathology*; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000502:physiology / Q000503:physiopathology* / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D049628:Body Size; D001830:Body Surface Area; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult