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Normative Aortic Valvar Measurements in Adults Using Cardiac Computed Tomography - A Potential Guide to Further
Yu Izawa1, Shumpei Mori1, Justin T Tretter2,3
1Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine.
Insights
This study reveals normal aortic valve dimensions in living hearts using 3D imaging. Aortic leaflets elongate to maintain coaptation, crucial for valve-sparing surgery planning.
Area of Science:
- Cardiovascular anatomy
- Medical imaging
- Surgical planning
Background:
- Aortic valve-sparing surgery requires detailed anatomical knowledge.
- 3D anatomical relationships of normal aortic valve dimensions in vivo are not fully understood.
Purpose of the Study:
- To investigate the 3D morphology of the aortic root and valve leaflets in living subjects.
- To establish normal dimensional standards for the aortic root and leaflets.
Main Methods:
- Coronary computed tomographic angiography was performed on 123 patients.
- Multiplanar reconstruction was used to measure aortic root and leaflet dimensions (interleaflet triangle height, geometric height, free margin length, effective height, coaptation length).
Main Results:
- Established average dimensions for aortic root and leaflet parameters.
- Identified specific leaflet characteristics (e.g., right coronary leaflet).
- Found positive correlations between geometric height, free margin length, effective height, and aortic root size, while coaptation length remained constant.
Conclusions:
- Living-heart datasets revealed characteristic relationships among aortic root dimensions.
- Aortic leaflets compensate for aortic root dilatation by elongating to maintain coaptation.
- These findings provide standard values for understanding aortic regurgitation and planning aortic valve-sparing surgery.
Background:
A thorough understanding of the anatomy of the aortic valve is necessary for aortic valve-sparing surgery. Normal valvar dimensions and their relationships in the living heart, however, have yet to be fully investigated in a 3-dimensional fashion.
Methods And Results:
In total, 123 consecutive patients (66±12 years, Men 63%) who underwent coronary computed tomographic angiography were enrolled. Mid-diastolic morphology of the aortic roots, including height of the interleaflet triangles, geometric height, free margin length of each leaflet, effective height, and coaptation length were measured using multiplanar reconstruction images. Average height of the interleaflet triangle, geometric height, free margin length, effective height, and the coaptation length were 17.3±1.8, 14.7±1.3, 32.6±3.6, 8.6±1.4, and 3.2±0.8 mm, respectively. The right coronary aortic leaflet displayed the longest free margin length and shortest geometric height. Geometric height, free margin length, and effective height showed positive correlations with aortic root dimensions. Coaptation length, however, remained constant regardless of aortic root dimensions.
Conclusions:
Diversities, as well as characteristic relationships among each value involving the aortic root, were identified using living-heart datasets. The aortic leaflets demonstrated compensatory elongation along with aortic root dilatation to maintain constant coaptation length. These measurements will serve as the standard value for revealing the underlying mechanism of aortic regurgitation to plan optimal aortic valve-sparing surgery.
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