Aortic root changes before and after surgery for chronic aortic dilatation: A 3D echocardiographic study

Area of Science:

• Cardiovascular Imaging
• Cardiac Surgery
• Quantitative Echocardiography

Background:

• Quantitative 3D assessment of the aortic root is crucial for improving aortic valve (AV)-sparing operations.
• Chronic aortic dilatation significantly impacts aortic root shape and aortic regurgitation (AR) severity.

Purpose of the Study:

• To assess the effects of chronic aortic dilatation on aortic root shape and AR severity using 3D transesophageal echocardiography (TEE).
• To evaluate the impact of AV-sparing operations on aortic root morphology and function.

Main Methods:

• Studied 48 patients: 23 with aortic dilatation (mild or moderate AR) and 25 controls.
• Utilized 3D-TEE and multiplanar reconstruction to measure aortic root dimensions and a novel parameter, total coaptation surface area (TCoapSA).
• Assessed a subgroup of 15 patients pre- and post-AV-sparing surgery.

Main Results:

• Patients with aortic dilatation exhibited larger aortic root areas, inter-commissural distances, and cusp heights compared to controls.
• Severe AR was associated with significantly smaller TCoapSA and shorter coaptation height.
• AV-sparing surgery significantly increased TCoapSA, coaptation height, and reduced inter-commissural distances.

Conclusions:

• The aortic valve dynamically remodels in response to aortic dilatation.
• Successful AV-sparing surgery effectively corrects these dilatations and remodeling changes.
• Quantitative modeling of the aortic valve and root can personalize repair strategies and improve surgical outcomes.