Morphological modification of the aortic annulus in tricuspid and bicuspid valves after aortic valve reimplantation: an electrocardiography-gated computed tomography study†

Abstract OBJECTIVES: Aortic valve-sparing operations have been shown to produce fewer valve-related complications than valve replacement. The aortic root is a morphological and functional unit in which the annulus plays an important role on dynamism, shape and geometry of the valve with different results in bicuspid aortic valves (BAVs) or tricuspid aortic valves (TAVs). The aim is to evaluate the differences in the size and shape of the aortic annulus between native BAVs and TAVs using ECG-gated computed tomography (CT) after a reimplantation procedure. METHODS: We selected 35 patients scheduled for aortic valve reimplantation who underwent good-quality preoperative and postoperative ECG-gated contrast-enhanced CT scan of the aortic root. Twenty-three patients had TAV, 8 patients type 1 BAV and 4 patients type 0 BAV. Major diameter and minor diameter, perimeter (P) and area (A) were measured. The shape of the aortic annulus was considered ‘circular’ or ‘elliptic’ according to the Ellipticity Index. We also selected a subgroup of 18 patients (9 TAVs and 9 BAVs) to evaluate annular shape and size variations through the cardiac cycle and to study the expansibility both in the preoperative and in the postoperative phases. RESULTS: Preoperative CT scans showed an elliptic shape of TAVs (Ellipticity Index 1.3 ± 0.1), a circular shape of type 0 BAVs (1.1 ± 0.1) and an intermediate behaviour of type 1 BAVs, suggesting a possible gradual spectrum of circularity from TAVs to type 1 BAVs to type 0 BAVs. Postoperative CT scans did not show any significant difference in annular shape among the 3 groups, which demonstated a similar roundness, obviating the preoperative differences. Analysing the expansibility of the aortic annulus during the cardiac cycle, we observed that it was completely absent in the preoperative phase in BAVs, while in the postoperative phase, both TAVs and BAVs showed a small but similar expansibility after the annular reduction. CONCLUSIONS: There is a possible gradual spectrum in terms of shape, from native TAVs, to type 1 BAVS to type 0 BAVs. These differences are eliminated in the postoperative phase, suggesting an active role of the annuloplasty on the geometry of the aortic annulus. The preoperative analysis showed a complete inelasticity of BAVs, which was partly restored in the postoperative phase.

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Inter-individual variance and cardiac cycle dependency of aortic root dimensions and shape as assessed by ECG-gated multi-slice computed tomography in patients with severe aortic stenosis prior to transcatheter aortic valve implantation: is it crucial for correct sizing?

The International Journal of Cardiovascular Imaging ◽

10.1007/s10554-012-0123-4 ◽

2012 ◽

Vol 29 (3) ◽

pp. 693-703 ◽

Cited By ~ 31

Author(s):

Lukas Lehmkuhl ◽

Borek Foldyna ◽

Konstantin Von Aspern ◽

Christian Lücke ◽

Matthias Grothoff ◽

...

Keyword(s):

Computed Tomography ◽

Aortic Valve ◽

Aortic Stenosis ◽

Transcatheter Aortic Valve Implantation ◽

Aortic Root ◽

Cardiac Cycle ◽

Severe Aortic Stenosis ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Valve Implantation

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Comparison of aortic root dimension changes during cardiac cycle between the patients with and without aortic valve calcification using ECG-gated 64-slice and dual-source 256-slice computed tomography scanners: results of a multicenter study

The International Journal of Cardiovascular Imaging ◽

10.1007/s10554-013-0217-7 ◽

2013 ◽

Vol 29 (6) ◽

pp. 1391-1400 ◽

Cited By ~ 11

Author(s):

Abbas Arjmand Shabestari ◽

Ramin Pourghorban ◽

Mahmood Tehrai ◽

Hamidreza Pouraliakbar ◽

Taraneh Faghihi Langroudi ◽

...

Keyword(s):

Computed Tomography ◽

Aortic Valve ◽

Multicenter Study ◽

Aortic Root ◽

Cardiac Cycle ◽

Aortic Valve Calcification ◽

Valve Calcification ◽

Tomography Scanners ◽

Dual Source

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P3378Differences in valve morphology and aortopathy between patients with bicuspid and tricuspid aortic valves: a Computed Tomography Study

European Heart Journal ◽

10.1093/eurheartj/ehz745.0254 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Nassar ◽

G Perlman ◽

Z Arow ◽

J Lessick ◽

A Segev ◽

...

Keyword(s):

Computed Tomography ◽

Aortic Valve ◽

Aortic Root ◽

Aortic Annulus ◽

Agatston Score ◽

Valve Morphology ◽

Transcatheter Aortic Valve ◽

Type Ia ◽

Aortic Leaflet ◽

Valve Implantation

Abstract Background Transcatheter aortic valve implantation (TAVI) has been shown safe and feasible in patients with bicuspid aortic valve (BAV) morphology. Evaluation of differences in valve morphology and aortic root dimensions in patients with BAV in comparison to patients with tricuspid aortic valve (TAV) is important for the spread of TAVI in patients with BAV. Purpose The present study evaluated the prevalence of BAV subtypes and the differences in valve morphology and aortic root dimensions between BAV and TAV in patients undergoing computed tomography (CT) before TAVI. Methods In five medical centers in Israel, 104 patients (69±13.5 years) with BAV and 105 patients (81±8.22 years) with TAV underwent CT angiography. BAV morphology was defined according to the number of commissures and raphe following Siever's classification. Functional BAV was defined as 3 cusps with focal fusion of 1, 2, or 3 commissures. Aortic root dimensions were measured at the level of the aortic annulus, sinus of Valsalva (SOV), sino-tubular junction (STJ), and ascending aorta (AA). Membranous septum (MS) length was measured in coronal view. The volume and agatston score of aortic valve calcification were evaluated. Results Type 0 account for 22% (23/104), type IA for 58% (60/104), Type IC for 9% (9/104), functional BAV for 11% (12/104). Type IB and II were not found in the studied population. As compared with TAV, patients with BAV have significantly larger aortic annulus area, SOV area, STJ area and AA Area; however, the ellipticity index of aortic annulus, SOV, STJ, and AA were similar. MS length was significantly smaller in patients with BAV compared to patients with TAV (6.4±2.3 mm vs. 8.1±2.7mm; retrospectively; P<0.001) and the volume of aortic valve calcifications was significantly higher in BAV compared to TAV patients: 2.3±1.6 ml3 vs. 1.4±1.2 ml3 retrospectively; P=0.003). Conclusions In Israel, patients with BAV showed more frequently type 1A BAV. BAV patients have larger aortic root dimensions than patients with TAV without difference in regard to the ellipticity index. MS length was smaller and the amount of aortic leaflet calcifications was higher in patients with BAV. These findings may have important impact on procedural outcome.

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Valve-sparing operations on the aortic valve and the ascending aorta: radical correction of congenital and acquired heart diseases. Immediate outcomes

Russian Journal of Transplantology and Artificial Organs ◽

10.15825/1995-1191-2021-1-84-90 ◽

2021 ◽

Vol 23 (1) ◽

pp. 84-90

Author(s):

G. A. Akopov ◽

T. N. Govorova ◽

A. S. Ivanov

Keyword(s):

Aortic Valve ◽

Aortic Root ◽

Heart Diseases ◽

Ascending Aorta ◽

Artificial Organs ◽

Tricuspid Valve Repair ◽

Type I ◽

Aortic Valves ◽

Valve Sparing ◽

Aortic Valve Reimplantation

This paper presents the immediate outcomes of valve-sparing operations on the aortic valve and ascending aorta in radical correction of congenital and acquired heart disease. Materials and methods. The study enrolled 50 patients with aortic insufficiency who were operated upon at Shumakov National Medical Research Center of Transplantology and Artificial Organs from 2011 to 2019. The mean age was 48 ± 16 years, 64% of them were men (n = 32). The study included patients with tricuspid (n = 36, 72%) and bicuspid (n = 14, 28%) aortic valves. Aortic valve reimplantation was performed in 32 (64%) patients, aortic root remodeling - in 1 (2%). 17 (34%) patients had no aortic root reconstruction or remodeling. Aortic valve reimplantation was done in 4 (8%) cases in combination with coronary artery bypass grafting, and in 4 (8%) with mitral and tricuspid valve repair. Results. Thirty-day mortality was 0%. In 1 case (2%), a permanent pacemaker was installed due to complete atrioventricular block. There were no neurological and coronary events, and cases of endocarditis. In all patients (100%), aortic valve insufficiency after surgical correction did not exceed grade 1 according to echocardiographic follow-up examination. On aortic valve mean and peak gradients were 8 ± 6 and 15 ± 7 mm Hg, respectively. Findings. Type I and II valve-sparing reconstructive surgery (for bicuspid and tricuspid aortic valves) is an excellent alternative to prosthetic repair with great postoperative outcomes, low valve-associated complications and low mortality.

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