Aortic root geometry in patients with aortic stenosis assessed by real-time three-dimensional transesophageal echocardiography.
BACKGROUND
The authors hypothesized that aortic root geometry is different between bicuspid and tricuspid aortic stenosis (AS) that can be assessed using real-time three-dimensional (3D) transesophageal echocardiography. The aims of this study were (1) to validate the accuracy of 3D transesophageal echocardiographic measurements of the aortic root against multidetector computed tomography as a reference, (2) to determine the difference of aortic root geometry between patients with tricuspid and bicuspid AS, and (3) to assess its impact on pressure recovery.


METHODS
In protocol 1, 3D transesophageal echocardiography and contrast-enhanced multidetector computed tomography were performed in 40 patients. Multiplanar reconstruction was used to measure the aortic annulus, the sinus of Valsalva, and the sinotubular junction area, as well as the distance and volume from the aortic annulus to the sinotubular junction. In protocol 2, the same 3D transesophageal echocardiographic measurements were performed in patients with tricuspid AS (n = 57) and bicuspid AS (n = 26) and in patients without AS (n = 32). The energy loss coefficient was also measured in patients with AS.


RESULTS
In protocol 1, excellent correlations of aortic root geometric parameters were noted between the two modalities. In protocol 2, compared with patients without AS, those with tricuspid AS had smaller both sinotubular junction areas and longitudinal distances, resulting in a 23% reduction of aortic root volume. In contrast, patients with bicuspid AS had larger transverse areas and longitudinal distances, resulting in a 30% increase in aortic root volume. The energy loss coefficient revealed more frequent reclassification from severe AS to moderate AS in patients with tricuspid AS (17%) compared with those with bicuspid AS (10%).


CONCLUSIONS
Three-dimensional transesophageal echocardiography successfully revealed different aortic root morphologies between tricuspid and bicuspid AS, which have different impacts on pressure recovery.
Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.
Victor Chien-Chia
VC
Wu
Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.
Kyoko
K
Kaku
Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan. Electronic address: takeuchi@med.uoeh-u.ac.jp.
Masaaki
M
Takeuchi
Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.
Kyoko
K
Otani
Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.
Hidetoshi
H
Yoshitani
Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.
Masahito
M
Tamura
Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.
Haruhiko
H
Abe
Department of Second Section of Cardiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan.
Fen-Chiung
FC
Lin
Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.
Yutaka
Y
Otsuji
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000000981:diagnostic imaging*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging*; D001027:Aortography; D003199:Computer Systems; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
2D; 3D; AS; AVA; AVA(2DCE); Aortic root geometry; Aortic stenosis; Aortic valve area; Bicuspid aortic stenosis; ELCo; Energy loss coefficient; MDCT; Multidetector computed tomography; STJ; Sinotubular junction; TAVR; TEE; Three-dimensional; Three-dimensional echocardiography; Transcatheter aortic valve replacement; Transesophageal echocardiography; Tricuspid aortic stenosis; Two-dimensional; Two-dimensional aortic valve area by the continuity equation