title: Structure and function of the tricuspid and bicuspid regurgitant aortic valve: an echocardiographic study.
abstract: OBJECTIVE
  The emerging new treatment options for aortic valve disease call for more sophisticated diagnostics. We aimed to describe the echocardiographic pathophysiology and characteristics of the purely regurgitant aortic valve in detail.
  
  
  METHODS
  Twenty-nine men, with chronic aortic regurgitation without concomitant heart disease referred for aortic valve intervention, underwent 2D transoesophageal echocardiographic (TEE) examination prior to surgery according to a previously published matrix. Measurements of the aortic valve apparatus in long and short axis view were made in systole and diastole and analysed off-line. The aortic valves were grouped as tricuspid (TAV) or bicuspid (BAV), and classified by regurgitation mechanism.
  
  
  RESULTS
  Twenty-four examinations were eligible for analysis of which 13 presented TAV and 11 BAV. The regurgitation mechanism was classified as dilatation of the aorta in 6 cases, as prolapse in 11 cases and as poor cusp tissue quality or quantity in 7 cases. The ventriculo-aortic junction (VAJ) and valve opening were closely related (TAV r = 0.5, BAV r = 0.73) but no correlation was found between the VAJ and the maximal sinus diameter (maxSiD) or the sinotubular junction (STJ). However, the STJ and maxSiD were significantly related (TAV vs BAV: systole r = 0.9, r = 0.8; diastole r = 0.9, r = 0.7), forming an entity. The conjoined BAV cusps were shorter than the anterior cusps when closed (P = 0.002); the inter-commissural distances of the cusps in the BAV group were significantly different (P = 0.001 resp. 0.03) in both systole and diastole.
  
  
  CONCLUSIONS
  The VAJ was independent of other aortic dimensions and should thereby be considered as a separate entity with influence on valve opening. The detailed 2D TEE measurements of this study add further important information to our knowledge about the function and echocardiographic anatomy of the pathological aortic valve and root either as a stand-alone examination or as a benchmark and complement to 3D echocardiography. This may have an impact on decisions regarding repairability of the native aortic valve.
authors.affiliation: Department of Clinical Physiology, University of Linköping, Linköping, Sweden Department of Cardiothoracic Surgery, Heart and Medicine Centre, Linköping, Sweden Division of Cardiovascular Medicine, Department of Medical and Health Sciences, University of Linköping, Linköping, Sweden mattias.ronnerfalk@regionostergotland.se.
authors.forename: Mattias
authors.initials: M
authors.lastname: Rönnerfalk
authors.affiliation: Department of Cardiothoracic Surgery, Heart and Medicine Centre, Linköping, Sweden Division of Cardiovascular Medicine, Department of Medical and Health Sciences, University of Linköping, Linköping, Sweden.
authors.forename: Éva
authors.initials: É
authors.lastname: Tamás
mesh_terms: D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000503:physiopathology; D001022:Aortic Valve Insufficiency / Q000145:classification / Q000000981:diagnostic imaging* / Q000503:physiopathology; D000082882:Bicuspid Aortic Valve Disease; D017548:Echocardiography, Transesophageal; D006349:Heart Valve Diseases / Q000145:classification / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis
keywords: Aortic valve insufficiency; Bicuspid valve; Cardiac surgery; Transoesophageal echocardiography; Tricuspid valve