Aortic valve and aortic root features in CT angiography in patients considered for aortic valve repair

Calcification and atheroma plaques: is there any impact on the anatomical features of the aortic root and its elements?

OBJECTIVES

Morphometric information of the structures within the borders of the aortic root is a guide for surgical interventions. It is essential to determine the effects of aortic calcification and atheroma plaque findings on the structures of this region. This study aims to establish the normal values of aortic root structures and to investigate the impact of pathologic findings in order to guide diagnosis and treatment in the clinic.

METHODS

The aortic root structures were morphometrically analyzed in fresh hearts of 110 patients (89 males, 21 females) brought to the forensic medicine institution. The distances between the bases of the aortic sinuses, their widths and heights, and the lengths of the commissures were measured to differentiate between pathologic and non-pathologic aortic classes. Parameters were compared according to gender, age, body mass index, and body surface area.

RESULTS

The mean age was 44.71 ± 15.57 years in 21 female patients and 53.66 ± 15.67 years in 89 male patients. The results of the pathologic aorta group with calcification and atheroma plaque findings were higher than the non-pathologic aorta group in all parameters (P < .05).

CONCLUSIONS

Calcification and the presence of atheroma plaque in the aorta increase the size of the structures at the aortic root. Gender, age, body mass index, and body surface area are among the criteria that will cause changes in the structures of this region. These results will help surgeons to know the normal values of aortic root structures and to consider the effects of pathologic findings in aortic valve repair operations.

Multimodality Evaluation of Aortic Insufficiency and Aortitis in Rheumatologic Diseases

Aortic insufficiency is commonly observed in rheumatologic diseases such as ankylosing spondylitis, systemic lupus erythematosus, antiphospholipid syndrome, Behçet's disease, granulomatosis with polyangiitis, and Takayasu arteritis. Aortic insufficiency with an underlying rheumatologic disease may be caused by a primary valve pathology (leaflet destruction, prolapse or restriction), annular dilatation due to associated aortitis or a combination of both. Early recognition of characteristic valve and aorta morphology on cardiac imaging has both diagnostic and prognostic importance. Currently, echocardiography remains the primary diagnostic tool for aortic insufficiency. Complementary use of computed tomography, cardiac magnetic resonance imaging and positron emission tomography in these systemic conditions may augment the assessment of underlying mechanism, disease severity and identification of relevant non-valvular/extracardiac pathology. We aim to review common rheumatologic diseases associated with aortic insufficiency and describe their imaging findings that have been reported in the literature.

Focus on the annuloplasty in aortic valve repair: implications from a quantitative multislice computed tomography analysis

Background

Aortic valve (AV) repair has evolved towards a treatment alternative in young patients with AV regurgitation and was accompanied by the development of surgical repair strategies. An efficient and reproducible AV annulus stabilization (i.e., annuloplasty) has been proposed as a crucial component to obtain the long-term stability of AV repair. However, there is still major controversy regarding the most appropriate annuloplasty approach. We aimed to address AV annulus structures which are relevant for AV annuloplasty, based on MS-CT data.

Methods

We retrospectively analysed 326 consecutive patients with AV disease who all underwent preprocedural MS-CT examination. Study cohort was subdivided according to the underlying AV pathology: 25 patients with aortic regurgitation (AR subgroup) (mean age 73±11 years, 68% male), 243 patients with aortic stenosis (AS subgroup) (73±11 years, 68% male) and 58 patients with normally functioning AV (normal AV subgroup) (mean age 76±7 years, 36% male). We systematically measured maximum and minimum AV annulus diameter, AV annular area, projected AV annular perimeter and anatomic AV annular perimeter during mid-systole using MS-CT data. Based on these measurements, AV annular eccentricity index was calculated [(max AV annulus × 100/min AV annulus) - 100]. Furthermore, we assessed the tissue components of AV annular plane, distinguishing between muscular and fibrous portions of the basal ring.

Results

AV annular eccentricity index was significantly larger in the normal AV-subgroup as compared to the AR-subgroup (33.2%±10.7% vs. 27.8%±9.2%; P=0.048) as well as to the AS-subgroup (33.2%±10.7% vs. 20.4%±8.8%; P<0.001). AV annular area was significantly larger in the AR subgroup as compared to the AS subgroup (5.7±1.0 vs. 5.1±0.8 cm²; P=0.003) and normal AV subgroup (5.7±1.0 vs. 4.8±0.8 cm²; P<0.001). Intramuscular plane in the right coronary sinus was significantly increased in the AR subgroup vs. AS subgroup (12.8±2.7 vs. 7.5±3.6 mm; P<0.001) and normal AV subgroup (12.8±2.7 vs. 8.7±3.0 mm; P<0.001). Muscular component of the basal ring was significantly reduced in the AR subgroup vs. AS subgroup (37.5%±5.1% vs. 40.5%±5.5%; P=0.039) and normal AV subgroup (37.5%±5.1% vs. 44.3%±10.2%; P=0.001).

Conclusions

MS-CT enables a quantitative analysis of aortic root anatomy which may have an impact on AV annuloplasty. AR patients differ significantly regarding their AV annular dimensions and basal ring morphology as compared to the AS patients and those with a normal AV function. These findings may have major implications in tricuspid AV repair when designing the most appropriate AV annulus stabilisation technique.