Comparison of the geometry of the left ventricle outflow tract, the aortic root and the ascending aorta in patients with severe tricuspid aortic stenosis versus healthy controls

Abstract The purpose of this study was to assess by multislice computed tomography (MSCT) imaging geometry of the ascending aorta, the aortic root, the aortic annulus and the left ventricle outflow tract (LVOT) in aortic stenosis (AS) patients, to compare aortic root morphology in patients with AS with healthy controls and to evaluate sex differences. Fifty patients with severe AS and 50 age- and gender-matched controls who underwent MSCT were included in the study. The dimensions of the LVOT, the aortic annulus, the aortic root, the ascending aorta, and the volume of the aortic root were retrospectively assessed and a comparison was made between patients with severe tricuspid AS and controls. Patients with tricuspid AS in comparison with controls had smaller dimensions of the sinus of Valsalva resulting in reduction of the aortic root volume, whereas the dimensions of the other structures were comparable. MSCT revealed larger annular, LVOT and the sinus of Valsalva dimensions and the aortic root volume in men than women. Men with AS differed from healthy men only in regard to the dimensions of the sinus of Valsalva, while women showed significant differences also in the LVOT, and the aortic annulus. MSCT showed accurately aortic root remodeling in tricuspid AS patients and indentified sex-dependent differences. Women with tricuspid AS differ from healthy women more than men did. A high degree of the variability in the aortic root dimensions requires further careful research.

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Geometric changes in aortic root replacement using Freestyle prosthesis

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01583-y ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Anja Osswald ◽

Alina Zubarevich ◽

Arian Arjomandi Rad ◽

Robert Vardanyan ◽

Konstantin Zhigalov ◽

...

Keyword(s):

Aortic Root ◽

Ascending Aorta ◽

Aortic Root Replacement ◽

Aortic Annulus ◽

Strongly Correlated ◽

Root Volume ◽

Concomitant Surgery ◽

Valve Size ◽

Operative Planning ◽

Geometric Changes

Abstract Background The Medtronic Freestyle prosthesis has proven to be a promising recourse for aortic root replacement in various indications. The present study aims to evaluate clinical outcomes and geometric changes of the aorta after Freestyle implantation. Methods Between October 2005 and November 2020, the computed tomography angiography (CTA) data of 32 patients were analyzed in a cohort of 68 patients that underwent aortic root replacement using Freestyle prosthesis. The minimum and maximum diameters and areas of the aortic annulus, aortic root, ascending aorta, and the proximal aortic arch were measured at a plane perpendicular to the long axis of the aorta using 3D multiplanar reconstruction in both the preoperative (n = 32) and postoperative (n = 10) CTAs. Moreover, volumetric changes of the aortic root and ascending aorta were quantified. Results Mean age was 64.6 ± 10.6 years. Indications for surgery using Freestyle prosthesis were combined aortic valve pathologies, aortic aneurysm or dissection, and endocarditis, with concomitant surgery occurring in 28 out of 32 patients. In-hospital mortality was 18.6%. Preoperative diameter and area measurements of the aortic annulus strongly correlated with the implanted valve size (p < 0.001). Bicuspid valve was present in 28.1% of the patients. Diameter and areas of the aortic root decreased after freestyle implantation, resulting in a reduction of the aortic root volume (45.6 ± 26.3 cm3 to 18.7 ± 4.5 cm3, p = 0.029). Volume of the aortic root and the ascending aorta decreased from 137.3 ± 65.2 cm3 to 54.5 ± 21.1 cm3 after Freestyle implantation (p = 0.023). Conclusion Implantation of the Freestyle prosthesis presents excellent results in restoring the aortic geometry. Preoperative CTA measurements are beneficial to the surgical procedure and valve selection and therefore, if available, should be considered in pre-operative planning.

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Scaling to produce size-independent indices of echocardiographic derived aortic root dimensions in elite Rugby Football League players

Ultrasound ◽

10.1177/1742271x18818607 ◽

2019 ◽

Vol 27 (2) ◽

pp. 94-100 ◽

Cited By ~ 2

Author(s):

Simon A Oates ◽

Lynsey Forsythe ◽

John D Somauroo ◽

Keith P George ◽

Michael Papadakis ◽

...

Keyword(s):

Surface Area ◽

Body Surface Area ◽

Body Surface ◽

Aortic Root ◽

Allometric Scaling ◽

Ascending Aorta ◽

Aortic Annulus ◽

Linear Scaling ◽

Sinus Of Valsalva ◽

Sinotubular Junction

The assessment of aortic root dimensions is important in cardiac pre-participation screening. Scaling of cardiac dimensions removes the impact of body size allowing meaningful inter/intra group comparisons. Developing appropriate scaling approaches, scaling variables and extending the application to major vessels is warranted so underlying pathology can be detected and managed appropriately. The study aims to define relationships between aortic root dimensions and body surface area/height. Two hundred and twenty elite Rugby Football League athletes were recruited. All participants completed anthropometric assessments, a 12-lead ECG and echocardiogram. Aortic root was measured at the aortic annulus, sinus of valsalva, sinotubular junction and the proximal ascending aorta. Linear and allometric scaling were performed on the relationship between aortic measurements and body surface area/height. Absolute aortic root measurements fell within normal population data (mean ± standard deviation (range): aortic annulus: 22 ± 2 (17–28) mm, sinus of valsalva: 28 ± 3 (20–38) mm, sinotubular junction: 22 ± 3 (14–33) mm, proximal ascending aorta: 22 ± 3 (15–31) mm). Linear scaling to height produced size-independent indices at all aortic measurement sites (P < 0.05). Conversely, linear scaling using body surface area did not produce size-independent indices at any site (P > 0.05). Allometric scaling, using both body surface area and height, produced size-independent indices at all sites (P < 0.05). We recommend linearly scaling aortic root dimensions to height in elite Rugby Football League athletes and discourage the use of body surface area as a linear scaling quantity. Allometric scaling is also effective when using both body surface area and height.

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Aortic Root Finite Element Modeling From MR Imaging

ASME 2008 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2008-193026 ◽

2008 ◽

Author(s):

Carlo A. Conti ◽

Emiliano Votta ◽

Alessandro Della Corte ◽

Luca Del Viscovo ◽

Maurizio Cotrufo ◽

...

Keyword(s):

Finite Element ◽

Left Ventricle ◽

Mr Imaging ◽

Finite Element Modeling ◽

Aortic Root ◽

Ascending Aorta ◽

Outflow Tract ◽

Sinotubular Junction ◽

Element Modeling ◽

Concomitant Factors

The aortic root is the portion of the outflow tract of the left ventricle that includes the aortic leaflets, the aortic annulus, the sinuses of Valsalva and the sinotubular junction. The impairment of one or more of these structures can lead not only to dysfunctions of the root, but also to alterations of the adjacent anatomical sites, such as the ascending aorta. The raise and the progress of the alterations are often related to more concomitant factors, whose separated effect can be difficult to assess. At this purpose computational finite element (FE) models can be a useful tool, given their capability the recreate different scenarios by varying one or more parameters of the model in a controlled fashion.

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Increased aortic root diameters in patients with acromegaly

Acta Endocrinologica ◽

10.1530/eje-08-0138 ◽

2008 ◽

Vol 159 (2) ◽

pp. 97-103 ◽

Cited By ~ 22

Author(s):

Agatha A van der Klaauw ◽

Jeroen J Bax ◽

Johannes W A Smit ◽

Eduard R Holman ◽

Victoria Delgado ◽

...

Keyword(s):

Aortic Root ◽

Clinical Manifestations ◽

Left Ventricular ◽

Ascending Aorta ◽

Inactive Disease ◽

Valvular Regurgitation ◽

Healthy Controls ◽

Aortic Sinus ◽

Sinotubular Junction

ObjectiveThe clinical manifestations of acromegalic cardiomyopathy include arrhythmias, valvular regurgitation, concentric left ventricular (LV) hypertrophy, and LV systolic and diastolic dysfunction. At present, it is unknown whether acromegaly also affects the aortic root.DesignAortic root diameters were prospectively assessed in 37 acromegalic patients (18 patients with active disease and 19 with controlled disease) by conventional two-dimensional and Doppler echocardiography before, and after, an observation period of 1.9 years (range 1.5–3.0 years). Baseline parameters were compared with healthy controls.ResultsThe diameters of the aortic root at the sino-tubular junction and the ascending aorta were increased in patients with acromegaly: 30±4 vs 26±3 mm (P=0.0001) and 33±5 vs 30±4 mm (P=0.006) respectively. The diameter of the aortic root at the aortic annulus and aortic sinus were not different from controls. During follow-up, the aortic root diameters increased at the levels of the annulus and the sinotubular junction (P=0.025 and P=0.024 respectively), whereas there was no change in the diameters at the levels of the sinus and the ascending aorta during follow-up. Baseline aortic root diameters were not influenced by disease duration, current disease activity, or blood pressure. When patients with active and inactive disease were analyzed separately, only the diameter of the sinotubular junction increased in patients with inactive acromegaly during follow-up (P=0.031).ConclusionAortic root diameters are increased in patients with acromegaly compared with healthy controls.

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Giant pseudo-aneurysm of the left ventricle outflow tract after aortic root replacement for extensive endocarditis

European Journal of Cardio-Thoracic Surgery ◽

10.1016/j.ejcts.2009.04.010 ◽

2009 ◽

Vol 36 (2) ◽

pp. 399-399 ◽

Cited By ~ 4

Author(s):

Kaushal K. Tiwari ◽

Michele Murzi ◽

Massimiliano Mariani ◽

Mattia Glauber

Keyword(s):

Left Ventricle ◽

Aortic Root ◽

Outflow Tract ◽

Aortic Root Replacement ◽

Pseudo Aneurysm

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In vitro estimation of the energy loss through turbulence in a porcine aortic valve stenosis model and silicone ascending aorta phantom using backlight particle tracking velocimetry

European Heart Journal ◽

10.1093/eurheartj/ehab724.0122 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

M Chiarelli ◽

S F De Marchi ◽

D Obrist ◽

E Buffle

Keyword(s):

Left Ventricle ◽

Aortic Stenosis ◽

Energy Loss ◽

Particle Tracking Velocimetry ◽

Ascending Aorta ◽

Low Flow ◽

Mean Flow ◽

Flow Rates ◽

Stenosis Severity

Abstract Introduction Patients suffering from low-flow, low-gradient aortic stenosis present a decreased stroke volume due to decreased contraction or relaxation function of the left ventricle. As a low stroke volume tends to cause a low transvalvular flow, transvalvular pressure gradient (TVPG) and effective orifice area, the clinician cannot rely on those parameters with confidence for the evaluation of aortic stenosis severity. Hence new diagnostic parameters have to be developed. Energy loss through turbulence associated with aortic stenosis represented the wasted left ventricle work. Currently, echocardiographic measurement of the turbulence intensity is not validated for clinical evaluations of aortic stenosis. Methods Two porcine aortic valves were harvested and inserted in a flow loop that replicates the pulsatile flow of the heart. A stiffening of the valves was achieved by treating them with formaldehyde. The stiffening was externally confirmed by a custom-made force-displacement device quantifying the rigidity of the leaflet yielding two stiffness grades per valve. Each valve was tested under three different mean flow rates (1, 2.5, and 4 l/min) at each of the two stiffness grades. Moreover the pressure in the left ventricle chamber and in the aortic chamber was recorded to calculate the TVPG. Particle tracking velocimetry measurements into the transparent silicone ascending aorta phantom allowed the computation of the turbulent kinetic energy (TKE), to evaluate the energy loss due to turbulence. Results We could confirm the enhanced rigidity of the valve leaflets with our custom device (data not shown) and measure a consistent increase in TVPG across all mean flow rates between the two stiffness grades. Moreover, an explicit increase of the TKE in the aortic phantom could be measured after the stiffening process (73.1% under 1 l/min, and 43% under both 2.5 and 4 l/min). In addition, a good correlation (R = 0.86) between the mean TVPG and the TKE was found. Conclusions This project demonstrated the possibility of quantifying the energy loss attributed to turbulence for porcine valves in vitro for native and added stiffness grade. This project lays the foundation for the development of a new diagnostic tool for the assessment of stenosis severity in patients with low-flow, low-gradient aortic stenosis in cardiac imaging tool such as echocardiography. FUNDunding Acknowledgement Type of funding sources: None. TVPG and its correlation with TKE Intensity graphs of the TKE

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INDIRECT ULTRASOUND EVALUATION OF LEFT VENTRICULAR OUTFLOW TRACT DIAMETER IMPLICATIONS FOR HEART FAILURE AND AORTIC STENOSIS SEVERITY ASSESSMENT.

10.22541/au.160615093.39506877/v1 ◽

2020 ◽

Author(s):

Gabriele Pestelli ◽

Andrea Fiorencis ◽

Valeria Pergola ◽

Giovanni Luisi ◽

Vittorio Smarrazzo ◽

...

Keyword(s):

Heart Failure ◽

Aortic Stenosis ◽

Aortic Root ◽

Left Ventricular Outflow Tract ◽

Ventricular Outflow Tract ◽

Left Ventricular ◽

Outflow Tract ◽

Regression Equation ◽

Ultrasound Evaluation ◽

Left Ventricular Outflow

Background. Whereas dependency of left ventricular outflow tract diameter (LVOTD) from body surface area (BSA) has been established and a BSA-based LVOTD formula has been derived, the relationship between LVOTD and aortic root and LV dimensions has never been explored. This may have implications for evaluation of LV output in heart failure (HF) and aortic stenosis (AS) severity. Methods. A cohort of 540 HF patients who underwent transthoracic echocardiography was divided in a derivation and validation subgroup. In the derivation subgroup (N=340) independent determinants of LVOTD were analyzed to derive a regression equation, which was used for predicting LVOTD in the validation subgroup (N=200) and compared with the BSA-derived formula. Results. LVOTD determinants in the derivation subgroup were sinuses of Valsalva diameter (SVD, beta=0.392, P<0.001), BSA (beta=0.229, P<0.001), LV end-diastolic diameter (LVEDD, beta=0.145, P=0.001), and height (beta=0.125, P=0.037). The regression equation for predicting LVOTD with the aforementioned variables (LVOTD=6.209+[0.201xSVD]+[1.802xBSA]+[0.03xLVEDD]+[0.025xHeight]) did not differ from (P=0.937) and was highly correlated with measured LVOTD (R=0.739, P<0.001) in the validation group. Repeated analysis with LV end-diastolic volume instead of LVEDD and/or accounting for gender showed similar results, whereas BSA-derived LVOTD values were different from measured LVOTD (P<0.001). Conclusion. Aortic root and LV dimensions affect LVOTD independently from anthropometric data and are included in a new comprehensive equation for predicting LVOTD. This should improve evaluation of LV output in HF and severity of AS, avoiding use of LVOT velocity-time integral alone, which can be misleading, especially when LV cavity and aortic root dimensions are abnormal.

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Rare Case of Ruptured Sinus of Valsalva: Ruptured Into Left Ventricular Cavity

Cardiovascular Journal ◽

10.3329/cardio.v4i1.9398 ◽

1970 ◽

Vol 4 (1) ◽

pp. 96-98

Author(s):

SDM Taimur ◽

SR Khan ◽

MR Karim ◽

MH Rahman

Keyword(s):

Left Ventricle ◽

Aortic Root ◽

Rare Case ◽

Interventricular Septum ◽

Rare Condition ◽

Left Ventricular ◽

Left Ventricular Cavity ◽

Sinus Of Valsalva ◽

Sinus Of Valsalva Aneurysm ◽

Left Sinus Of Valsalva

Rupture sinus of Valsalva is a relatively rare condition. We report a rare case of ruptured left sinus of valsalva with aneurysm, presenting with acute left ventricular failure. Transthoracic echocardiography showed an aneurysmal dilatation of the base of interventricular septum and part of the aortic root and a marked turbulent flow from the aortic root to the left ventricle with a continuous systolodiastolic shunting. The patient underwent successful repair of ruptured sinus of valsulva with closure of fistula. During Ventriculotomy the defect was repaired using pledgeted 5/ 0 prolene interrupted sutures and pericardial patch. Key Words: Rupture sinus of valsalva; Aneurysm; Left ventricle DOI: http://dx.doi.org/10.3329/cardio.v4i1.9398 Cardiovasc. J. 2011; 4(1): 96-98

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Metabolic Modulation and Potential Biomarkers of the Prognosis Identification for Severe Aortic Stenosis after TAVR by a Metabolomics Study

Cardiology Research and Practice ◽

10.1155/2020/3946913 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9

Author(s):

Yanbiao Liao ◽

Chang Liu ◽

Tianyuan Xiong ◽

Mingyue Zhao ◽

Wen Zheng ◽

...

Keyword(s):

Mass Spectrometry ◽

Left Ventricle ◽

Aortic Stenosis ◽

Coronary Sinus ◽

Metabolic Profile ◽

Ascending Aorta ◽

Peripheral Vein ◽

Metabolism Pathway ◽

Before And After ◽

Potential Biomarkers

Objectives. To investigate the metabolic profile in patients with aortic stenosis (AS) after transcatheter aortic valve replacement (TAVR) and explore the potential biomarkers to predict prognosis after TAVR based on metabolomics. Methods and Results. Fifty-nine consecutive AS patients were prospectively recruited. Blood samples from the ascending aorta, coronary sinus, and peripheral vein at before and after TAVR were collected, respectively. Liquid chromatography-mass spectrometry and gas chromatography-mass spectrometry were performed to analyze the metabolic profile before and after TAVR. Influential metabolites were identified by integrating the univariate test, multivariate analysis, and weighted gene coexpression network analysis (WGCNA) algorithm. PLS-DA analysis revealed a significant extremely early (within 30 minutes after TAVR) alterations of metabolites in the ascending aorta, coronary sinus, and peripheral vein. The early (within 7 days after TAVR) changed metabolites in the peripheral vein were involved in purine metabolism, primary bile acid biosynthesis, glycerolipid metabolism, amino sugar and nucleotide sugar metabolism, one carbon pool by folate and alanine, and the aspartate and glutamate metabolism pathway. We used volcano plots to find that the cardiac-specific changed metabolites were enriched to the sphingolipid metabolism pathway after TAVR. Besides, WGCNA algorithm was performed to reveal that arginine and proline metabolites could reflect left ventricle regression to some extent. Conclusion. This is the first study to reveal systemic and cardiac metabolites changed significantly in patients with AS after TAVR. Some altered metabolites involved in the arginine and proline metabolism pathway in the peripheral vein could predict left ventricle regression, which merited further study.

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Anatomical and clinical predictors of valve dysfunction and aortic dilation in bicuspid aortic valve disease

Heart ◽

10.1136/heartjnl-2017-311560 ◽

2017 ◽

Vol 104 (7) ◽

pp. 566-573 ◽

Cited By ~ 26

Author(s):

Arturo Evangelista ◽

Pastora Gallego ◽

Francisco Calvo-Iglesias ◽

Javier Bermejo ◽

Juan Robledo-Carmona ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Regurgitation ◽

Bicuspid Aortic Valve ◽

Aortic Root ◽

Ascending Aorta ◽

Clinical Predictors ◽

Valve Dysfunction ◽

Tertiary Hospitals ◽

Male Sex

ObjectiveBicuspid aortic valve (BAV) is associated with early valvular dysfunction and proximal aorta dilation with high heterogeneity. This study aimed to assess the determinants of these complications.MethodsEight hundred and fifty-two consecutive adults diagnosed of BAV referred from cardiac outpatient clinics to eight echocardiographic laboratories of tertiary hospitals were prospectively recruited. Exclusion criteria were aortic coarctation, other congenital disorders or intervention. BAV morphotype, significant valve dysfunction and aorta dilation (≥2 Z-score) at sinuses and ascending aorta were established.ResultsThree BAV morphotypes were identified: right–left coronary cusp fusion (RL) in 72.9%, right–non-coronary (RN) in 24.1% and left–non-coronary (LN) in 3.0%. BAV without raphe was observed in 18.3%. Multivariate analysis showed aortic regurgitation (23%) to be related to male sex (OR: 2.80, p<0.0001) and valve prolapse (OR: 5.16, p<0.0001), and aortic stenosis (22%) to BAV-RN (OR: 2.09, p<0.001), the presence of raphe (OR: 2.75, p<0.001), age (OR: 1.03; p<0.001), dyslipidaemia (OR: 1.77, p<0.01) and smoking (OR: 1.63, p<0.05). Ascending aorta was dilated in 76% without differences among morphotypes and associated with significant valvular dysfunction. By contrast, aortic root was dilated in 34% and related to male sex and aortic regurgitation but was less frequent in aortic stenosis and BAV-RN.ConclusionsNormofunctional valves are more prevalent in BAV without raphe. Aortic stenosis is more frequent in BAV-RN and associated with some cardiovascular risk factors, whereas aortic regurgitation (AR) is associated with male sex and sigmoid prolapse. Although ascending aorta is the most commonly dilated segment, aortic root dilation is present in one-third of patients and associated with AR. Remarkably, BAV-RL increases the risk for dilation of the proximal aorta, whereas BAV-RN spares this area.

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