Aortic root geometry in patients with aortic stenosis assessed by real-time three-dimensional transesophageal echocardiography.
BACKGROUND
The authors hypothesized that aortic root geometry is different between bicuspid and tricuspid aortic stenosis (AS) that can be assessed using real-time three-dimensional (3D) transesophageal echocardiography. The aims of this study were (1) to validate the accuracy of 3D transesophageal echocardiographic measurements of the aortic root against multidetector computed tomography as a reference, (2) to determine the difference of aortic root geometry between patients with tricuspid and bicuspid AS, and (3) to assess its impact on pressure recovery.


METHODS
In protocol 1, 3D transesophageal echocardiography and contrast-enhanced multidetector computed tomography were performed in 40 patients. Multiplanar reconstruction was used to measure the aortic annulus, the sinus of Valsalva, and the sinotubular junction area, as well as the distance and volume from the aortic annulus to the sinotubular junction. In protocol 2, the same 3D transesophageal echocardiographic measurements were performed in patients with tricuspid AS (n = 57) and bicuspid AS (n = 26) and in patients without AS (n = 32). The energy loss coefficient was also measured in patients with AS.


RESULTS
In protocol 1, excellent correlations of aortic root geometric parameters were noted between the two modalities. In protocol 2, compared with patients without AS, those with tricuspid AS had smaller both sinotubular junction areas and longitudinal distances, resulting in a 23% reduction of aortic root volume. In contrast, patients with bicuspid AS had larger transverse areas and longitudinal distances, resulting in a 30% increase in aortic root volume. The energy loss coefficient revealed more frequent reclassification from severe AS to moderate AS in patients with tricuspid AS (17%) compared with those with bicuspid AS (10%).


CONCLUSIONS
Three-dimensional transesophageal echocardiography successfully revealed different aortic root morphologies between tricuspid and bicuspid AS, which have different impacts on pressure recovery.
['Wu|Victor Chien-Chia|VC|', 'Kaku|Kyoko|K|', 'Takeuchi|Masaaki|M|', 'Otani|Kyoko|K|', 'Yoshitani|Hidetoshi|H|', 'Tamura|Masahito|M|', 'Abe|Haruhiko|H|', 'Lin|Fen-Chiung|FC|', 'Otsuji|Yutaka|Y|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D001011:Aorta D001024:Aortic Valve Stenosis D001027:Aortography D003199:Computer Systems D019560:Echocardiography, Three-Dimensional D017548:Echocardiography, Transesophageal D005260:Female D006801:Humans D007090:Image Interpretation, Computer-Assisted D008297:Male D008875:Middle Aged D015203:Reproducibility of Results D012680:Sensitivity and Specificity D014057:Tomography, X-Ray Computed
Aortic root geometry Aortic stenosis Three-dimensional Transesophageal echocardiography Tricuspid aortic stenosis AS 3D Multidetector computed tomography Sinotubular junction Energy loss coefficient 2D AVA AVA(2DCE) Aortic valve area Bicuspid aortic stenosis ELCo MDCT STJ TAVR TEE Three-dimensional echocardiography Transcatheter aortic valve replacement Two-dimensional Two-dimensional aortic valve area by the continuity equation