title: Feasibility of in vivo human aortic valve modeling using real-time three-dimensional echocardiography.
abstract: BACKGROUND
  Surgical techniques for aortic valve (AV) repair are directed toward restoring normal structural relationships in the aortic root and rely on detailed assessment of root and valve anatomy. Noninvasive three-dimensional (3D) imaging and modeling may assist in patient selection and operative planning.
  
  
  METHODS
  Transesophageal real-time 3D echocardiographic images of 5 patients with normal AVs were acquired. The aortic root and the annulus were manually segmented at end diastole using a 36-point rotational template. The AV leaflets and the coaptation zone were manually segmented in parallel 1-mm cross sections. Quantitative 3D models of the AV and root were generated and used to measure standard anatomic parameters and were compared to conventional two-dimensional echocardiographic measurements. All measurements are given as mean±SD.
  
  
  RESULTS
  Annular, sinus, and sinotubular junction areas were 4.1±0.6 cm2, 7.5±1.2 cm2, and 3.9±1.0 cm2, respectively. Root diameters (measured in three locations) by 3D model inspection and two-dimensional echocardiography measurement correlated (R2=0.75). Noncoapted areas of the left, right, and noncoronary leaflets were 1.9±0.2 cm2, 1.6±0.3 cm2, and 1.6±0.3 cm2, respectively. Mean coaptation areas for the left-right, left-noncoronary, and right-noncoronary coaptation zones were 87.7±36.9 mm2, 69.9±20.7 mm2, and 114.2±23.0 mm2, respectively. The mean ratio of noncoapted leaflet area to annular area was 1.3±0.2.
  
  
  CONCLUSIONS
  High-resolution 3D models of the in vivo normal human aortic root and valve were generated using 3D echocardiography. Quantitative 3D models and analysis may assist in characterization of pathology and decision making for AV repair.
authors: Gorman Cardiovascular Research Group, University of Pennsylvania, Glenolden, Pennsylvania; Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Arminder S
authors: AS
authors: Jassar
authors: Gorman Cardiovascular Research Group, University of Pennsylvania, Glenolden, Pennsylvania.
authors: Melissa M
authors: MM
authors: Levack
authors: Gorman Cardiovascular Research Group, University of Pennsylvania, Glenolden, Pennsylvania.
authors: Ricardo D
authors: RD
authors: Solorzano
authors: Gorman Cardiovascular Research Group, University of Pennsylvania, Glenolden, Pennsylvania.
authors: Alison M
authors: AM
authors: Pouch
authors: Gorman Cardiovascular Research Group, University of Pennsylvania, Glenolden, Pennsylvania; Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Giovanni
authors: G
authors: Ferrari
authors: Department of Anesthesiology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Albert T
authors: AT
authors: Cheung
authors: Division of Cardiology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Victor A
authors: VA
authors: Ferrari
authors: Gorman Cardiovascular Research Group, University of Pennsylvania, Glenolden, Pennsylvania; Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Joseph H
authors: JH
authors: Gorman
authors: Gorman Cardiovascular Research Group, University of Pennsylvania, Glenolden, Pennsylvania; Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Robert C
authors: RC
authors: Gorman
authors: Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: benjamin.jackson@uphs.upenn.edu.
authors: Benjamin M
authors: BM
authors: Jackson
mesh_terms: D001021:Aortic Valve / Q000000981:diagnostic imaging*; D019560:Echocardiography, Three-Dimensional; D005240:Feasibility Studies; D006801:Humans; D008955:Models, Cardiovascular; D013997:Time Factors