Dynamic Three-Dimensional Geometry of the Aortic Valve Apparatus-A Feasibility Study

Area of Science:

• Cardiovascular Imaging
• Cardiac Surgery
• Echocardiography

Background:

• The aortic valve (AV) apparatus is crucial for cardiac function.
• Understanding its normal anatomy and dynamic behavior is essential for surgical interventions.
• Three-dimensional transesophageal echocardiography (3D TEE) offers detailed visualization.

Purpose of the Study:

• To present the anatomy and nomenclature of the aortic valve apparatus.
• To provide data on normal AV apparatus geometry and dynamics during the cardiac cycle using 3D TEE.

Main Methods:

• Retrospective feasibility study involving 10 patients with normal aortic valves undergoing surgery.
• Intraoperative 3D TEE was performed using Siemens ACUSON SC2000.
• Semiautomated dynamic analysis of the AV apparatus using Siemens eSie valve software.

Main Results:

• Significant changes in AV apparatus dimensions (annulus, sinus of Valsalva, sinotubular junction) and leaflet coaptation occurred during the cardiac cycle (p < 0.001).
• The sinotubular junction exhibited greater expansion than the annulus and sinus of Valsalva (p < 0.001).
• Leaflet height changes varied between leaflets, with left and right coronary leaflets showing greater changes.

Conclusions:

• Semiautomated dynamic assessment of the AV apparatus with eSie valve software is clinically feasible in the operating room.
• This technique can aid intraoperative decision-making for aortic valve repair.
• The aortic valve apparatus is a dynamic structure with significant cardiac cycle-dependent geometric alterations.