Study of aortic valve using multi slice computed tomography in patients presenting with chest pain

2021 ◽  
Vol 71 (9) ◽  
Author(s):  
Mubarra Nasir ◽  
Hafiz Muhammad Shafique ◽  
Farhan Tuyyab ◽  
Rehana Khadim
Keyword(s):  
Chest Pain ◽  
Aortic Valve ◽  
Aortic Root ◽  
Heart Diseases ◽  
Armed Forces ◽  
Breath Hold ◽  
Aortic Valve Area ◽  
Cross Sectional ◽  
Sinotubular Junction ◽  
The Mean

Abstract Objective: To determine aortic root dimensions in younger patients presenting with chest pain. Study Design: Descriptive cross sectional study Study Setting: CT Angiography Department of Armed Forces Institute of Cardiology & National Institute of Heart Diseases, Rawalpindi. Duration of study:6 months (from 12th September 2018 to 11th March 2019) Methods: MSCT angiography was performed over all the patients who met the inclusion and exclusion criteria after written informed consent .MSCT acquisition was performed in a single breath-hold of about 5–10 seconds, ECG gated synchronized data acquisition with 60-100ml contrast was done.Multiphase data sets were reconstructed followed by data analysis. Required measurements were recorded with software caliper and tracer. All data were analyzed in SPSS 23. Results: Recruited in the study were a total of 330 patients who fulfilled the inclusion criteria. Mean age (years) was45.5±7.9 and there were 236 (71.5%) male and 94 (28.5%) female patients in the study. Bicuspid aortic valve was found in 0.9%(n=3) of population whereas 99.1%(n=320) were tricuspid. The mean aortic valve area was 4.01±0.70cm2, mean aortic annular size was 21.9±2.37mm,Sinotubular junction diameter on average was found to 23.9±3.45mm, and mean sinotubular junction height was 21.09±2.77mm.The diameter at sinuses of Valsalva was found to be 33.0±3.99mm. Conclusion: The mean aortic root dimensions and general morphology of aortic valve was determined in our population to establish normal reference values, which will later help in therapeutic strategies in patients suffering from aortic valve disease. MSCT was utilized in the assessment of these parameters, also proves Continuous...

scholarly journals Emirati Women’s Knowledge about the Menopause and Menopausal Hormone Therapy

2020 ◽  
Vol 17 (13) ◽  
pp. 4875
Author(s):  
Linda Smail ◽  
Ghufran A. Jassim ◽  
Khawla I. Sharaf
Keyword(s):  
Hormone Therapy ◽  
Heart Diseases ◽  
Menopausal Status ◽  
Cross Sectional Study ◽  
Menopausal Hormone Therapy ◽  
Cross Sectional ◽  
Reproductive Characteristics ◽  
The Mean ◽  
Women's Knowledge ◽  
Women’S Knowledge

The aim of this study was to investigate the knowledge of Emirati women aged 30–64 about menopause, menopausal hormone therapy (MHT), and their associated health risks, and additionally, to determine the relationships between Emirati women’s knowledge about menopause and their sociodemographic and reproductive characteristics. A community-based cross-sectional study was conducted of 497 Emirati women visiting five primary healthcare centers in Dubai. Data were collected using a questionnaire composed of sociodemographic and reproductive characteristics, menopause knowledge scale (MKS), and menopause symptoms knowledge and MHT practice. The mean menopause symptoms knowledge percentage was 41%, with a standard deviation of 21%. There were significant differences in the mean knowledge percentage among categories of education level (p < 0.001) and employment (p = 0.003). No significant differences in the knowledge percentages were found among categories of menopausal status. “Pregnancy cannot occur after menopause” was the statement with the highest knowledge percentage (83.3%), while the lowest knowledge percentages were “risk of cardiovascular diseases increases with menopause’’ (23.1%), “MHT increases risk of breast cancer’’ (22.1%), and “MHT decreases risk of colon cancer’’ (13.9%). The knowledge of Emirati women about menopause, MHT, and related heart diseases was very low; therefore, an education campaign about menopause and MHT risks is needed to improve their knowledge for better coping with the symptoms.

scholarly journals Planning strategies and practical implementation of the cardiac dose reduction in the left-side breast irradiation with the deep inspiration breath-hold (DIBH) method

2017 ◽  
Vol 3 (2) ◽  
pp. 347-350
Author(s):  
Linda Wagner ◽  
Thomas Koch ◽  
Antje Fahrig
Keyword(s):  
Dose Reduction ◽  
Maximum Dose ◽  
Heart Diseases ◽  
Thoracic Wall ◽  
Breath Hold ◽  
Practical Implementation ◽  
Deep Inspiration ◽  
Deep Inspiration Breath Hold ◽  
Increased Risk ◽  
The Mean

AbstractBackground: Despite of the use of tangential beam directions during the irradiation of mammary carcinomas, a dose reduction of the heart cannot always be achieved. This is decivise for the increased risk of heart diseases and the associated mortality. Especially affected is the cardiac apex. However, by using respiratory gated treatment techniques, like the deep inspiration breath-hold (DIBH), a dose sparing of this area can be reached.Material and Methods: The Elekta ABC system was used to control the respiratory stop of early staged breast cancer patients. The treatment planning was implemented by a 3D and VMAT technique. The focus was the optimization of irradiation plans and the evaluation of the respective dose exposure to the heart, the left ventricle and the left anterior descending coronary artery (LAD artery). A planning concept of 28 x 2,25 Gy in the SIB and 28 x 1,8 Gy in the left breast was used.Results: The results showed that a dose reduction of 30-40% in mean and maximal in all structures is possible by using the VMAT technique in combination with the ABC system. In the case of 3D irradiation planning, a substantial relief can only be seen at the mean dose exposure of approximately 50%. Also, only a maximum dose reduction of 13% could be achieved.Conclusion: The mean dose reduction was mainly achieved by the increased distance between the heart and the thorax wall. The maximum dose was reduced by the volumentric optimization algortihm of the VMAT and the resulting steeper dose fall-off at the inner thoracic wall. Due to the lack of this optimization and thus the greater dose drop, the maximum dose of the 3D plans could only reduced by 13%.

Abstract 9916: Evaluation of the Best Cut-off Value of Ischemia in Instantaneous Wave-Free Ratio in Patients With Aortic Valve Stenosis

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Hiroyuki Arashi ◽  
Junichi Yamaguchi ◽  
Tonre Ri ◽  
Eiji Shibahashi ◽  
Ryosuke Itani ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Stenosis ◽  
Coronary Stenosis ◽  
Pressure Ratio ◽  
Aortic Valve Area ◽  
Fractional Flow ◽  
Clinical Value ◽  
Flow Reserve ◽  
Significant Difference ◽  
The Mean

Background: Instantaneous wave-free ratio (iFR) is a vasodilator free index calculated using trans-lesional pressure ratio during a specific period of diastole that is called “wave-free period”, and reported to have a good correlation with fractional flow reserve (FFR). In patients with severe aortic valve stenosis (AS), evaluation of intermediate coronary stenosis by FFR using vasodilators is thought to be a contraindication in some situations. Moreover, previous studies reported unique coronary flow pattern during diastolic phase in patients with AS. To date, there is no report claiming the correlation of iFR and FFR in this population. The purpose of the present study was to examine the clinical value of iFR in patients with AS. Method and Results: We examined consecutive 154 patients (with 214 stenosis) whose iFR and FFR were measured simultaneously. The mean age of AS patients (n=10, mean aortic valve area: 0.75 ± 0.42cm2) was higher than non-AS patients (n=144). Other patients’ characteristics are shown in Table 1. The mean iFR value in AS patients was significantly lower than that of non-AS patients, despite no significant difference was observed in the mean FFR value and % diameter stenosis (Table 2). iFR showed a good correlation with FFR in AS patients (Figure 1) and the best cut-off value of iFR in receiver operator curve analysis to predict FFR ≤ 0.8 was 0.73 in AS patients (AUC 0.84, sensitivity 0.8, specificity 0.86, p=0.016; Figure 2), whereas, 0.90 in non-AS patients. Conclusion: The present study demonstrated the good correlation between iFR and FFR in AS patients. Besides, the value below 0.73 of iFR was thought to be a predictor of myocardial ischemia in AS patients, which was lower than standard predictive range of ischemia in iFR. Vasodilator-free assessment by iFR may have potential benefits in evaluating intermediate coronary stenosis in patients with AS.

Abstract 6190: Outcomes of Carotid Stenting in Patients with Concomitant Severe Carotid and Aortic Stenosis Prior to Aortic Valve Replacement

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Subrata Kar ◽  
Mehdi H Shishehbor ◽  
E. Murat Tuzcu ◽  
Deepak L Bhatt ◽  
Christopher Bajzer ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Open Heart Surgery ◽  
Cleveland Clinic ◽  
Carotid Stenting ◽  
Aortic Valve Area ◽  
Close Monitoring ◽  
The Mean

Introduction: Carotid stenosis increases the risk for perioperative stroke during open heart surgery. Patients with concomitant severe carotid and aortic stenosis (AS) are frequently referred for carotid intervention prior to aortic valve replacement. Hypothesis: We hypothesized that carotid stenting can be safe and efficacious in the setting of severe AS. Methods: Of the total of 829 consecutive patients that underwent carotid interventions from 1998 –2005 at the Cleveland Clinic, 52 patients (65% male, age 78.82 ± 26.16 years) with severe AS (aortic valve area ≤ 1.0 cm 2 , 0.71 ± 0.15 cm 2 ) were included. Demographic, echocardiographic, and angiographic data were obtained prospectively. Our primary endpoints were stroke, transient ischemic attacks (TIAs), or death. Results: The mean STS Mortality scores for all groups were 6.85 ± 4.53% (n=46), six patient scores were immeasurable. There were no procedural strokes or mortality. TIA occurred in 1 patient during carotid stenting. Thirty day mortality was 6% (2 patients with LV-EF <20% died from heart failure and arrhythmia and 1 died from pulmonary embolism). Two other patients with depressed EF expired >30 days after carotid stenting prior to planned aortic valve replacement (AVR). AVR was performed in 29 of the 52 patients (26 patients ≥ 30 days post carotid stenting and 3 patients <15 days post carotid stenting). Of the remaining 23 patients, AVR was not performed due to death (n=5), high surgical risk from medical comorbidities (n=7), and patient refusal (n=3). Close monitoring and reassessment was recommended in 8 patients with asymptomatic AS. The mean STS mortality scores for patients who underwent AVR and who did not have AVR were 6.88 ± 5.05% and 6.81 ± 4.08% respectively (p=ns). Conclusions: Carotid interventions can be safely accomplished in patients with severe AS prior to AVR.

Pulsatile Flow Characteristics in a Stenotic Aortic Valve Model: An In Vitro Experimental Study

2019 ◽  
Author(s):  
Ruihang Zhang ◽  
Yan Zhang
Keyword(s):  
Heart Rate ◽  
Cardiac Output ◽  
Aortic Valve ◽  
Pulsatile Flow ◽  
Heart Diseases ◽  
Flow Characteristics ◽  
Aortic Valve Area ◽  
Heart Rates ◽  
Valvular Heart Diseases

Abstract Aortic stenosis (AS) is one of the most common valvular heart diseases around the globe. The accurate assessment of AS severity is important and strongly associated with accurate interpretation of the hemodynamic parameters across the stenotic valve. In this study, we conducted in vitro fluid dynamic experiments to investigate the pulsatile flow characteristics of a stenotic aortic valve as a function of heart rate. An in vitro cardiovascular flow simulator was used to generate pulsatile flow with a prescribed waveform (40% systolic period and 4L/min cardiac output) under varied heart rates (50 bpm, 75 bpm and 100 bpm). The stenotic valve was constructed by molding silicone into three-leaflet aortic valve geometries wrapping around thin fabrics which increases its stiffness and tensile strength. Two-dimensional phase-locked particle image velocimetry (PIV) was employed to quantify the flow field characteristics of the stenotic valve. Pressure waveforms were recorded to evaluate the severity of the stenosis via the Gorlin and Hakki equations. Results suggest that as the heart rate increases, the peak pressure gradient across the stenotic aortic valve increases significantly under the same cardiac output. Analysis also shows the estimated aortic valve area (AVA) decreases as the heart rate increases under the same cardiac output using Gorlin equation estimation, while the trend is reversed using Hakki equation estimation. Under phase-locked conditions, quantitative flow characteristics, such as phase-averaged flow velocity, turbulence kinetic energy (TKE) for the stenotic aortic valve were analyzed based on the PIV data. Results suggest that the peak systolic jet velocity downstream of the valve increases as the heart rate increases, implying a longer pressure recovery distance as heart rate increases. While the turbulence at peak systole is higher under the slower heart rate, the faster heart rate contributes to a higher turbulence during the late systole and early diastole phases. Based on the comparison with no-valve cases, the differences in TKE was mainly related to the dynamics of leaflets under different heart rates. Overall, the results obtained in this study demonstrate that the hemodynamics of a stenotic aortic valve is complex and the assessment of AS could be significantly affected by the pulsating rate of the flow.

scholarly journals Aortic Valve Reconstruction with Use of Pericardial Leaflets in Adults with Bicuspid Aortic Valve Disease: Early and Midterm Outcomes

2014 ◽  
Vol 41 (6) ◽  
pp. 585-591 ◽  
Author(s):  
Meong Gun Song ◽  
Hyun Suk Yang ◽  
Jong Bum Choi ◽  
Je Kyoun Shin ◽  
Hyun Keun Chee ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Area Index ◽  
Sinotubular Junction ◽  
Artificial Graft ◽  
Valve Reconstruction ◽  
Initial Procedure ◽  
Hospital Deaths ◽  
The Mean ◽  
Leaflet Coaptation

In this study, we retrospectively analyzed the outcomes of adults with bicuspid aortic valve (BAV) disease who underwent aortic valve reconstructive surgery (AVRS), consisting of replacement of the diseased BAV with 2 or 3 pericardial leaflets plus fixation of the sinotubular junction for accurate and constant leaflet coaptation. From December 2007 through April 2013, 135 consecutive patients (mean age, 49.2 ± 13.1 yr; 73.3% men) with symptomatic BAV disease underwent AVRS. Raphe was observed in 84 patients (62.2%), and the remaining 51 patients had pure BAV without raphe. A total of 122 patients (90.4%) underwent 3-leaflet reconstruction, and 13 (9.6%) underwent 2-leaflet reconstruction. Concomitant aortic wrapping with an artificial graft was performed in 63 patients (46.7%). There were no in-hospital deaths and 2 late deaths (1.5%); 6 patients (4.4%) needed valve-related reoperation. The 5-year cumulative survival rate was 98% ± 1.5%, and freedom from valve-related reoperation at 5 years was 92.7% ± 3.6%. In the last available echocardiograms, aortic regurgitation was absent or trivial in 116 patients (85.9%), mild in 16 (11.9%), moderate in 2 (1.5%), and severe in one (0.7%). The mean aortic valve gradient was 10.2 ± 4.5 mmHg, and the mean aortic valve orifice area index was 1.3 ± 0.3 cm2/m2. The 3-leaflet technique resulted in lower valve gradients and greater valve areas than did the 2-leaflet technique. Thus, in patients with BAV, AVRS yielded satisfactory early and midterm results with low mortality rates and low reoperation risk after the initial procedure.

Aortic root enlargement to mitigate patient–prosthesis mismatch: do early adverse events justify reluctance?†

2019 ◽  
Vol 56 (2) ◽  
pp. 335-342 ◽  
Author(s):  
Josephina Haunschild ◽  
Sven Scharnowski ◽  
Meinhard Mende ◽  
Konstantin von Aspern ◽  
Martin Misfeld ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Aortic Root ◽  
Early Mortality ◽  
Surgical Aortic Valve Replacement ◽  
Patient Prosthesis Mismatch ◽  
The Mean ◽  
Aortic Root Enlargement

Abstract OBJECTIVES Concomitant aortic root enlargement (ARE) at the time of surgical aortic valve replacement can be performed to avoid patient–prosthesis mismatch, an important predictor of adverse long-term outcome. METHODS We performed a single-centre, retrospective analysis of 4120 patients receiving isolated aortic valve replacement, of whom 171 (4%) had concomitant ARE between January 2005 and December 2015. The analysis of postoperative outcome and early mortality was performed. Owing to inequality of the groups, patients were matched 1:1. RESULTS The mean age of all 4120 patients was 68.8 ± 10.5 years, and comorbidities were equally balanced after matching. The mean aortic cross-clamp time, cardiopulmonary bypass time and total operative time were prolonged by 19, 20 and 27 min in the ARE group, respectively. Early mortality was not statistically significantly different with 1.4% in the surgical aortic valve replacement and 1.8% in the ARE group. Postoperative complications were <5% in all matched 338 patients: bleeding (3% vs 3%), pericardial effusion (3.0% vs 4.2%), sternal instability (1.8% vs 0%) and sternal wound infection (3.0% vs 1.2%). A significant higher number of patients had respiratory failure after ARE (unmatched: 17.1% vs 9.9%, P < 0.001; matched: 18.3% vs 9.5%, P = 0.028). Factors independently associated with overall mortality were age [hazard ratio (HR) 1.71], chronic obstructive pulmonary disease (HR 1.47), diabetes (HR 1.82), atrial fibrillation (HR 2.14) and postoperative respiratory failure (HR 2.84). CONCLUSIONS ARE can be performed safely in experienced centres with no significant increase in the risk of early postoperative surgical complications and early mortality. However, the surgeon and the intensive care unit team should be aware of an increased risk for postoperative respiratory failure in ARE patients.

Abstract 13512: Sex-related Differences on Valvular Calcifications in Patients With Aortic Stenosis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Marianne Deslandes ◽  
Marine Clisson ◽  
Ezequiel Guzzetti ◽  
Alexandra Barriault ◽  
Erwan Salaun ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Aortic Valve ◽  
Independent Predictor ◽  
Cross Sectional Study ◽  
Aortic Valve Area ◽  
Mitral Annular Calcification ◽  
Cross Sectional ◽  
Multidetector Compute Tomography ◽  
Annular Calcification ◽  
Valve Area

Introduction: It has been shown that women present lower coronary artery (CAC) and aortic valve calcification (AVC) loads while heavier mitral annular calcification (MAC) than men. However, the sex-specific predictors to these cardiac calcifications remain poorly characterized. Methods: We conducted a cross-sectional study in patients with at least mild AS (indexed aortic valve area: AVAi < 1.5 cm 2 /m 2 , Peak aortic jet velocity: Vpeak > 2.0 m/s, or Mean gradient: MG >15 mmHg). Doppler-echocardiography and non-contrast multidetector compute tomography were performed within 3 months. Ascending aorta calcification (AAC), AVC, CAC and MAC scores were measured using the Agatston method. Descriptive statistical analyses (t-test, Wilcoxon, univariate and multivariate analysis) were performed. Results: We studied 406 patients (71±11 years, 33% women) with AVAi= 0.59±0.21 cm 2 /cm 2 , Vpeak= 3.1±9.8 m/s, MG= 24.7±17.8 mmHg (equivalent between men and women, all p>0.34). Women present less AVC (480[222-1191] vs 1005[485-2364]AU; p<0.0001), and CAC (366[50-914] vs 626[167-1354]AU; p=0.006), but more MAC (60[1-887] vs 48[0-363]AU; p=0.05) and AAC (227[43-863] vs 142[7-493]AU; p=0.03) than men. Even after comprehensive adjustment, sex remained an independent predictor of each cardiac calcification (all p<0.01). In multivariate analysis, correlates with higher AVC or higher MAC were sex dependent (cf. table). Collinearity was avoided with all variance inflating factor <2.5. Conclusion: In AS patients, sex is a powerful and independent predictor of cardiac calcifications. Moreover, predictors of valvular calcification appear to be sex specific.

Initial experience with xenograft bioconduit for the treatment of complex prosthetic valve endocarditis

Perfusion ◽  
2017 ◽  
Vol 32 (5) ◽  
pp. 383-388 ◽  
Author(s):  
Apostolos Roubelakis ◽  
Dimos Karangelis ◽  
Syed Sadeque ◽  
Bobby Yanagawa ◽  
Amit Modi ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Root ◽  
Prosthetic Valve ◽  
High Risk Patient ◽  
Recurrent Infection ◽  
Length Of Hospital Stay ◽  
Prosthetic Valve Endocarditis ◽  
Biological Tissues ◽  
Aortic Root Abscess ◽  
The Mean

Introduction: The treatment of complex prosthetic valve endocarditis (PVE) with aortic root abscess remains a surgical challenge. Several studies support the use of biological tissues to minimize the risk of recurrent infection. We present our initial surgical experience with the use of an aortic xenograft conduit for aortic valve and root replacement. Methods: Between October 2013 and August 2015, 15 xenograft bioconduits were implanted for complex PVE with abscess (13.3% female). In 6 patients, concomitant procedures were performed: coronary bypass (n=1), mitral valve replacement (n=5) and tricuspid annuloplasty (n=1). The mean age at operation was 60.3±15.5 years. The mean Logistic European system for cardiac operating risk evaluation (EuroSCORE) was 46.6±23.6. The median follow-up time was 607±328 days (range: 172-1074 days). Results: There were two in-hospital deaths (14.3% mortality), two strokes (14.3%) and seven patients required permanent pacemaker insertion for conduction abnormalities (46.7%). The mean length of hospital stay was 26 days. At pre-discharge echocardiography, the conduit mean gradient was 9.3±3.3mmHg and there was either none (n=6), trace (n=6) or mild aortic insufficiency (n=1). There was no incidence of mid-term death, prosthesis-related complications or recurrent endocarditis. Conclusions: Xenograft bioconduits may be safe and effective for aortic valve and root replacement for complex PVE with aortic root abscess. Although excess early mortality reflects the complexity of the patient population, there was good valve hemodynamics, with no incidence of recurrent endocarditis or prosthesis failure in the mid-term. Our data support the continued use and evaluation of this biological prosthesis in this high-risk patient cohort.

scholarly journals Systolic stretching of the ascending aorta

2021 ◽  
Vol 17 (1) ◽  
pp. 25-30
Author(s):  
Tomasz Plonek ◽  
Bartosz Rylski ◽  
Pawel Nawrocki ◽  
Friedhelm Beyersdorf ◽  
Marek Jasinski ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Root ◽  
Ascending Aorta ◽  
Maximum Dimension ◽  
Heart Motion ◽  
Mean Diameter ◽  
The Mean ◽  
Valve Pathology

IntroductionLongitudinal stretching of the aorta due to systolic heart motion contributes to the stress in the wall of the ascending aorta. The objective of this study was to assess longitudinal systolic stretching of the aorta and its correlation with the diameters of the ascending aorta and the aortic root.Material and methodsAortographies of 122 patients were analyzed. The longitudinal systolic stretching of the aorta caused by the contraction of the heart during systole and the maximum dimensions of the aortic root and ascending aorta were measured in all patients.ResultsThe maximum dimension of the aortic root was on average 34.9 ±4.5 mm and the mean diameter of the ascending aorta was 33.9 ±5.4 mm. The systolic aortic stretching negatively correlated with age (r = –0.49, p < 0.001) and the diameter of the tubular ascending aorta (r = –0.44, p < 0.001). There was no significant correlation between the stretching and the dimension of the aortic root (r = –0.11, p = 0.239). There was a statistically significant (p < 0.001) difference in the longitudinal aortic stretching values between patients with a normal aortic valve (10.6 ±3.1 mm) and an aortic valve pathology (8.0 ±3.2 mm in all patients with an aortic valve pathology; 7.5 ±4.3 mm in isolated aortic stenosis, 8.5 ±2.9 mm in the case of isolated insufficiency, 8.2 ±2.8 mm for valves that were both stenotic and insufficient).ConclusionsSystolic aortic stretching negatively correlates with the diameter of the tubular ascending aorta and the age of the patients, and does not correlate with the diameter of the aortic root. It is lower in patients with an aortic valve pathology.

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