Sinus of Valsalva dilates disproportionately in aortic root aneurysm with moderate to severe aortic regurgitation: quantitative assessment by transesophageal echocardiography.
BACKGROUND
Geometric change of the aortic valve and root in patients with aortic root aneurysm has not been well investigated. The aim of this study was to quantitatively assess the characteristics of aortic valve and root morphology in patients with aortic root aneurysm.


METHODS
Ten aortic root aneurysm patients (eight males, group A) with moderate to severe aortic regurgitation and ten controls with normal aortic valves (seven males, group N) were examined by transesophageal echocardiography. We measured the diameter of the aortic annulus, sinus of Valsalva, sinotubular junction (STJ) and ascending aorta, and the length of the valve coaptation and annulus to the leaflet tip. We also measured the cusp projection area, STJ arc length, leaflet tip-Valsalva wall diameter and inter-commissural diameter in each Valsalva sinus/cusp [left coronary cusp (LCC), right coronary cusp (RCC), non-coronary cusp (NCC)].


RESULTS
The diameters of the sinus of Valsalva (P = 0.003), STJ (P = 0.005) and ascending aorta (P = 0.008) were more significantly enlarged in group A than in group N, and the valve coaptation length was significantly shorter in group A than in group N (3.1 ± 1.1 vs. 4.9 ± 1.1 mm/m(2), P = 0.007). Moreover, the annulus to leaflet tip length was significantly longer in group A than in group N (P = 0.049). There was no significant difference in the size of the LCC, RCC and NCC in group N, although there was disproportion in the size of those cusps in group A, with the largest being in RCCs.


CONCLUSIONS
In patients with aortic root aneurysm, Valsalva sinuses disproportionately dilate with different size, causing the loss of coaptation.
Department of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan. kichiro@med.kawasaki-m.ac.jp.
Koichiro
K
Imai
Department of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
Nozomi
N
Watanabe
Department of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
Akihiro
A
Hayashida
Department of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
Kikuko
K
Obase
Department of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
Tomoko
T
Maehama
Department of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
Ken
K
Saito
Department of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
Takahiro
T
Kawamoto
Department of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
Yoji
Y
Neishi
Department of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
Hiroyuki
H
Okura
Department of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
Kiyoshi
K
Yoshida
Aortic regurgitation; Aortic root aneurysm; Disproportionately; Transesophageal echocardiography