Three-dimensional transoesophageal echocardiography of the aortic valve and root: changes in aortic root dilation and aortic regurgitation.
OBJECTIVE
It has been hypothesized that in response to dilation of the aortic root, the aortic valve cusps may remodel to prevent aortic regurgitation (AR). The aim of the present study was to evaluate the association between aortic cusp dimensions and aortic root geometry.


RESULTS
Three-dimensional transoesophageal echocardiography was performed in 40 patients with aortic root dilation (mean age 57 ± 12 years, 75% men, 35% bicuspid aortic valve) and 20 controls with a normal aortic root (mean age 61 ± 13 years, 65% men). Aortic valve geometry was measured, and the ratio between closed cusp area and sinotubular junction (STJ) area as a measure of the aortic cusp remodelling relative to the aortic root dilation was assessed. Patients with aortic root dilation with tricuspid aortic valve (n = 26) showed significant increase in aortic cusp size. However, the closed cusp area to STJ area ratio was smaller in dilated aortic roots [0.88 (95% confidence interval: 0.78-0.98)] compared with normal aortic roots [1.22 (95% confidence interval: 1.02-1.41); P = 0.002]. In addition, in patients with central AR, there was insufficient cusp tissue, as suggested by a closed cusp area to STJ area ratio of 0.75 (95% confidence interval: 0.67-0.82), compared with relative excess of cusp tissue in eccentric AR with a ratio of 1.14 (95% confidence interval: 1.01-1.27; P < 0.001).


CONCLUSIONS
Aortic root dilation was associated with significant increase in aortic valve cusp size. However, this increase seemed insufficient to match aortic root size, particularly in central AR, whereas in eccentric AR, there was relative abundance of cusp tissue resulting in relative cusp prolapse.
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
Madelien V
MV
Regeer
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
Vasileios
V
Kamperidis
Department of Cardio-Thoracic Surgery of the Heart Lung Center Leiden, Leiden University Medical Center, Leiden, The Netherlands.
Michel I M
MIM
Versteegh
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
Martin J
MJ
Schalij
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
Nina Ajmone
NA
Marsan
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
Jeroen J
JJ
Bax
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
Victoria
V
Delgado
D000367:Age Factors; D000368:Aged; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging* / Q000473:pathology*; D016022:Case-Control Studies; D016001:Confidence Intervals; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging; D004452:Echocardiography / Q000379:methods; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D015588:Observer Variation; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D018709:Statistics, Nonparametric; D014261:Tricuspid Valve / Q000000981:diagnostic imaging* / Q000473:pathology*
3DTEE; aortic cusp remodelling; aortic root dilation