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The association between wedging of the aorta and cardiac structural anatomy as revealed using multidetector-row
Shumpei Mori1, Robert H Anderson2, Tomofumi Takaya1
1Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
Insights
Deeper aortic root wedging is linked to aging, male gender, obesity, and aortic changes. These factors influence how the aortic root sits within the heart base, impacting cardiac structures.
Area of Science:
- Cardiovascular Anatomy
- Medical Imaging
- Radiology
Background:
- The aortic root's position within the cardiac base is crucial but not fully understood.
- Systematic investigation of aortic wedging extent and its cardiac impact is lacking.
Purpose of the Study:
- To systematically analyze the extent of aortic root wedging.
- To identify predictors and correlations of aortic wedging within the cardiac base.
Main Methods:
- Coronary arterial computed tomographic angiography in 100 patients.
- Measurement of aortic wedging distance and assessment of related cardiac and lung parameters.
- Multivariate analysis to determine independent predictors.
Main Results:
- Mean aortic wedging was 42.7 ± 9.8 mm.
- Aging, male gender, BMI, absence of cardiomyopathy, aortic tilting/dilation, and lung volume predicted deeper wedging.
- Wedging correlated with left atrial roof/oval fossa height, right coronary artery shape, and aortic-left ventricular axis angulation.
Conclusions:
- Aortic root wedging is significantly influenced by demographic and cardiovascular factors.
- Age, gender, obesity, cardiac disease, and aortic morphology are key predictors.
- Understanding aortic wedging provides insights into cardiac base anatomy and potential structural relationships.
Abstract:
The aortic root is wedged within the cardiac base. The precise extent of aortic wedging, however, and its influence on the surrounding cardiac structures, has not been systematically investigated. We analysed 100 consecutive patients, who underwent coronary arterial computed tomographic angiography. We assessed the extent of aortic wedging by measuring the vertical distance between the non-adjacent aortic sinus and the inferior epicardium. A shorter distance indicates deeper aortic wedging. We assessed the tilt angle and diameter of the ascending aorta, the relative heights of the left atrial roof and the oval fossa, the shape of the proximal right coronary artery, the angle of the aorta relative to the left ventricular axis, and the lung volume. The mean extent of wedging was 42.7 ± 9.8 mm. Multivariate analysis revealed that ageing, male gender, increased body mass index, patients without cardiomyopathy, the extent of tilting and dilation of the ascending aorta, and lung volume were all independent predictors for deeper aortic wedging (R2 = 0.7400, P < 0.0001). The extent of wedging was additionally correlated with a relatively high left atrial roof (R2 = 0.1394, P < 0.0001) and oval fossa (R2 = 0.1713, P < 0.0001), the shepherd's crook shape of the proximal right coronary artery (R2 = 0.2376, P < 0.0001), and the narrowness of the angulation of the root relative to the left ventricular axis (R2 = 0.2544, P < 0.0001). In conclusion, ageing, male gender, obesity, background cardiac disease, aortic tilting and dilation, and lung volume are all correlated with the extent of wedging of the aortic root within the cardiac base.