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Aortic Root Anatomy Is Related to the Bicuspid Aortic Valve Phenotype
Journal of the American Society of Echocardiography ( IF 6.5 ) Pub Date : 2021-12-01 , DOI: 10.1016/j.echo.2021.11.012
Olivier Milleron 1 , Paul Masi 2 , Ludivine Eliahou 1 , Jean-François Paul 3 , Florence Arnoult 4 , Nadia Ould Ouali 5 , Emmanuel Lansac 6 , Richard Raffoul 7 , Quentin Pellenc 8 , Phalla Ou 9 , Guillaume Jondeau 10
Affiliation  

Background

Bicuspid aortic valve (BAV) is associated with an asymmetric (not circular) aortic root, resulting in variability in the aortic root diameter measurements obtained using different techniques. The objective of this study was to describe aortic root asymmetry, including its orientation in the thorax, in relation to the various phenotypes of BAV and its impact on aortic root diameter measurements obtained using transthoracic echocardiography.

Methods

Aortic root asymmetry, orientation of the largest root diameter, and orientation of the valve opening were studied using computed tomographic scans of patients with BAV without significant aortic valve dysfunction referred for evaluation of a thoracic aortic aneurysm. Eighty-five patients with BAV were evaluated; BAV with fusion of the left and the right coronary cusps (L-R BAV), with or without raphe (n = 63), was compared with BAV with fusion of the right coronary and noncoronary cusps (N-R BAV), with or without raphe (n = 22).

Results

Asymmetry of the aortic root and its orientation in the thorax can be predicted from BAV phenotype: orientation of the valve opening differed from orientation of the largest root diameter by nearly 75° in both groups. The angle of the largest root diameter with the reference sagittal plane was 64.3° in the L-R BAV group versus 143.1° in the N-R BAV group (P < .0001). Therefore, using the parasternal long-axis view on transthoracic echocardiography, in N-R BAV, the ultrasound beam is roughly parallel to the valve opening orientation and almost orthogonal to the maximum diameter of the root. On the contrary, in L-R BAV, the ultrasound beam is roughly perpendicular to the valve opening orientation and almost parallel to the maximum diameter of the root. Consequently, the parasternal long-axis view on transthoracic echocardiography significantly underestimates maximal aortic root diameter in N-R BAV and modestly underestimates root diameter in L-R BAV (−6.1 ± 0.96 vs −2.3 ± 0.47 mm, P = .0008).

Conclusions

Aortic root morphology in patients with BAV can be predicted by BAV phenotype: the largest root diameter is roughly perpendicular to the orientation of the valve opening. Therefore, echocardiographic measurements according to present recommendations (parasternal long-axis view) underestimate maximal diameter in patients with N-R BAV.



中文翻译:

主动脉根部解剖与二尖瓣主动脉瓣表型有关

背景

二尖瓣主动脉瓣 (BAV) 与不对称(非圆形)主动脉根部相关,导致使用不同技术获得的主动脉根部直径测量值存在差异。本研究的目的是描述主动脉根部不对称性,包括其在胸腔中的方向,与 BAV 的各种表型及其对使用经胸超声心动图获得的主动脉根部直径测量值的影响。

方法

使用计算机断层扫描对没有明显主动脉瓣功能障碍的 BAV 患者进行了研究,以评估主动脉根部的不对称性、最大根部直径的方向和瓣膜开口的方向,以评估胸主动脉瘤。评估了 85 名 BAV 患者;将左右冠状动脉瓣融合的 BAV (LR BAV),有或没有中缝 ( n  = 63),与右冠状动脉和非冠状动脉瓣融合的 BAV (NR BAV),有或没有中缝 ( n  = 22)。

结果

主动脉根部的不对称性及其在胸腔中的方向可以从 BAV 表型中预测:两组中瓣膜开口的方向与最大根部直径的方向相差近 75°。LR BAV 组最大牙根直径与参考矢状面的夹角为 64.3°,NR BAV 组为 143.1°(P < .0001)。因此,使用经胸超声心动图的胸骨旁长轴切面,在 NR BAV 中,超声束大致平行于瓣膜开口方向,几乎正交于根部的最大直径。相反,在 LR BAV 中,超声波束大致垂直于瓣膜打开方向,几乎平行于根部的最大直径。因此,经胸超声心动图的胸骨旁长轴视图显着低估了 NR BAV 的最大主动脉根部直径,并适度低估了 LR BAV 的根部直径(-6.1 ± 0.96 vs -2.3 ± 0.47 mm,P  = .0008)。

结论

BAV 患者的主动脉根部形态可以通过 BAV 表型来预测:最大的根部直径大致垂直于瓣膜开口的方向。因此,根据目前的建议(胸骨旁长轴视图)进行的超声心动图测量低估了 NR BAV 患者的最大直径。

更新日期:2021-12-01
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