Structure and function of the tricuspid and bicuspid regurgitant aortic valve: an echocardiographic study
2015 (English)In: Interactive Cardiovascular and Thoracic Surgery, ISSN 1569-9293, E-ISSN 1569-9285, Vol. 21, no 1, 71-76 p.Article in journal (Refereed) Published
OBJECTIVES: The emerging new treatment options for aortic valve disease call for more sophisticated diagnostics. We aimed to describe the echocardiographic pathophysiology and characteristics of the purely regurgitant aortic valve in detail.
METHODS: Twenty-nine men, with chronic aortic regurgitation without concomitant heart disease referred for aortic valve intervention, underwent 2D transoesophageal echocardiographic (TEE) examination prior to surgery according to a previously published matrix. Measurements of the aortic valve apparatus in long and short axis view were made in systole and diastole and analysed off-line. The aortic valves were grouped as tricuspid (TAV) or bicuspid (BAV), and classified by regurgitation mechanism.
RESULTS: Twenty-four examinations were eligible for analysis of which 13 presented TAV and 11 BAV. The regurgitation mechanism was classified as dilatation of the aorta in 6 cases, as prolapse in 11 cases and as poor cusp tissue quality or quantity in 7 cases. The ventriculo-aortic junction (VAJ) and valve opening were closely related (TAV r = 0.5, BAV r = 0.73) but no correlation was found between the VAJ and the maximal sinus diameter (maxSiD) or the sinotubular junction (STJ). However, the STJ and maxSiD were significantly related (TAV vs BAV: systole r = 0.9, r = 0.8; diastole r = 0.9, r = 0.7), forming an entity. The conjoined BAV cusps were shorter than the anterior cusps when closed (P = 0.002); the inter-commissural distances of the cusps in the BAV group were significantly different (P = 0.001 resp. 0.03) in both systole and diastole.
CONCLUSIONS: The VAJ was independent of other aortic dimensions and should thereby be considered as a separate entity with influence on valve opening. The detailed 2D TEE measurements of this study add further important information to our knowledge about the function and echocardiographic anatomy of the pathological aortic valve and root either as a stand-alone examination or as a benchmark and complement to 3D echocardiography. This may have an impact on decisions regarding repairability of the native aortic valve.
Place, publisher, year, edition, pages
Oxford University Press (OUP): Policy N / European Association for Cardio-thoracic Surgery , 2015. Vol. 21, no 1, 71-76 p.
Aortic valve insufficiency; Transoesophageal echocardiography; Tricuspid valve; Bicuspid valve; Cardiac surgery
Clinical Medicine Cardiac and Cardiovascular Systems
IdentifiersURN: urn:nbn:se:liu:diva-120278DOI: 10.1093/icvts/ivv072ISI: 000357527800013PubMedID: 25840434OAI: oai:DiVA.org:liu-120278DiVA: diva2:843026
Funding Agencies|Swedish Heart Lung Foundation [HLF 20120570]; ALF Grants from the County Council of Ostergotland, Sweden [LIO-204141]2015-07-242015-07-242016-04-01