title: The functional aortic annulus in the 3D era: focus on transcatheter aortic valve replacement for the perioperative echocardiographer.
abstract: The functional aortic annulus represents a sound clinical framework for understanding the components of the aortic root complex. Recent three-dimensional imaging analysis has demonstrated that the aortic annulus frequently is elliptical rather than circular. Comprehensive three-dimensional quantification of this aortic annular geometry by transesophageal echocardiography and/or multidetector computed tomography is essential to guide precise prosthesis sizing in transcatheter aortic valve replacement to minimize paravalvular leak for optimal clinical outcome. Furthermore, three-dimensional transesophageal echocardiography accurately can quantify additional parameters of the functional aortic annulus such as coronary height for complete sizing profiles for all valve types in transcatheter aortic valve replacement. Although it is maturing rapidly as a clinical imaging modality, its role in transcatheter aortic valve replacement is seen best as complementary to multidetector computed tomography in a multidisciplinary heart team model.
authors.affiliation: Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Prakash A
authors.initials: PA
authors.lastname: Patel
authors.affiliation: Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Jacob T
authors.initials: JT
authors.lastname: Gutsche
authors.affiliation: Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: William J
authors.initials: WJ
authors.lastname: Vernick
authors.affiliation: Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, PA.
authors.forename: Jay S
authors.initials: JS
authors.lastname: Giri
authors.affiliation: Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Kamrouz
authors.initials: K
authors.lastname: Ghadimi
authors.affiliation: Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Weiss
authors.affiliation: Cardiovascular Imaging, Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, PA.
authors.forename: Dinesh H
authors.initials: DH
authors.lastname: Jagasia
authors.affiliation: Thoracic Aortic Program, Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, PA.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Bavaria
authors.affiliation: Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Electronic address: yiandoc@hotmail.com.
authors.forename: John G T
authors.initials: JG
authors.lastname: Augoustides
mesh_terms: D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000601:surgery*; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D019990:Perioperative Care / Q000379:methods*; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*
keywords: Valve Academic Research Consortium; aortic annular area; aortic leaflets; coronary artery height; ellipse; functional aortic annulus; hinge points; multidetector computed axial tomography; paravalvular leak; three-dimensional transesophageal echocardiography; transcatheter aortic valve replacement; virtual ring