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Echocardiographic Description of the Anatomic Relations within the Normal Aortic Root
Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
2007 (English)In: The Journal of Heart Valve Disease, ISSN 0966-8519, Vol. 16, no 3, 240-246 p.Article in journal (Refereed) Published
Abstract [en]

Background and aim of the study: Diagnostic procedures continue to contain much hidden information that may substantially improve the understanding of the mechanisms of aortic valve disease and its treatment planning. The study aim, using transesophageal echocardiography (TEE), was to describe in detail the anatomical and physiological properties of the normal human aortic root in vivo.

Methods: The study included 32 patients referred for TEE for suspected cardiac sources of emboli, but diagnosed as normal. Images of the aortic valve in long axis (100-120∞) and short-axis (45-60∞) views were recorded in mid-systole and end-diastole. Parameters of the aortic root (subaortic diameter, sinotubular junction (STJ), maximal sinus diameter, sinus height, cusp diameter, cusp height, opening, coaptation and intercommissural distance) were measured. For repeatability and reliability, two investigators performed the same series of measurements on a subgroup of 11 patients.

Results: Aortic valve parameters proved to be independent of age, gender, body weight and height, and also of body mass index and body surface area. The subaortic diameter showed no statistically significant connection to maximal sinus diameter or to STJ. No connection was found between STJ and cusp or sinus length in the long-axis view. A simplified regression equation describes the STJ as being three-quarters of the maximal sinus diameter. The valve opening was found to be ca. 80% of the subaortic diameter in systole. Length of coaptation proved to be independent of aortic diameters, but was approximately half of the left coronary (LC) and right coronary (RC) cusp height in diastole. This measurement model proved to be both reliable and reproducible.

Conclusion: This reliable description of normal anatomic and geometric relations within the aortic root, through extended examination of the aortic root by echocardiography, may facilitate a better planning of aortic valve-preserving interventions.

Place, publisher, year, edition, pages
2007. Vol. 16, no 3, 240-246 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-13340OAI: oai:DiVA.org:liu-13340DiVA: diva2:18518
Available from: 2008-06-18 Created: 2008-06-18 Last updated: 2009-08-21
In thesis
1. Surgical treatment in chronic aortic regurgitation: Timing, results, prognosis and left ventricular function
Open this publication in new window or tab >>Surgical treatment in chronic aortic regurgitation: Timing, results, prognosis and left ventricular function
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Chronic aortic regurgitation (AR) of varying degree affects 13% of men and 8.5% of women. In persons with severe AR, the expected length of life and its quality are influenced. Some individuals remain asymptomatic for a long period, due to effective compensatory mechanisms, but dysfunction of the left ventricle (LV) usually begins before symptoms appear and can be irreversible by then. This thesis addresses questions of LV function and optimal time for operation of patients suffering from chronic AR. Moreover, detailed echocardiographic studies of the anatomy of the normal aortic valve have been performed to obtain a better understanding of the in vivo anatomic relations within the aortic root.

Patients with chronic AR, without concomitant cardiac disease, were studied both retrospectively (n=88) and prospectively (n=29) and the aortic valves of persons (n=32) free from cardiac disease were investigated.

For the retrospectively studied patients, survival was 82% at 10 years which is an improvement compared with previously published results. The majority of the patients, however, had LV dysfunction preoperatively. By studying patients prospectively by echocardiography, radionuclide ventriculography (MUGA) and cardiopulmonary exercise testing (CPET) our aim was to evaluate the predictive value of measurements of LV function at rest and during exercise for postoperative outcome. LV diameters were markedly elevated prior to and diminished significantly after surgery. Patients with an abnormal exercise ejection fraction (EF) response by MUGA preoperatively, presented the same reaction postoperatively. This could not be predicted by LV function determination at rest, or by NYHA functional class. In spite of median NYHA class II, these patients had a low work capacity on CPET, which was neither improved 6 months postoperatively nor correlated to echocardiographic LV dimensions. Thus, both MUGA and CPET may be useful complements for timing of surgery in patients with chronic AR.

Assuming that patients would benefit from preservation of their native valves the normal aortic valve was studied to gain detailed information about the echocardiographic anatomy and relations within the normal aortic root. This extended examination of the aortic root may facilitate a better planning of aortic valve‐preserving interventions in the future.

Place, publisher, year, edition, pages
Institutionen för medicin och hälsa, 2008. 50 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1069
Keyword
Aortic regurgitation, left ventricular function, exercise, physical capacity, echocardiography
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-12284 (URN)978-91-7393-857-0 (ISBN)
Public defence
2008-09-12, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 09:00 (English)
Opponent
Supervisors
Available from: 2008-06-18 Created: 2008-06-18 Last updated: 2012-05-09

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Tamás, ÉvaNylander, Eva

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