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Aortic cusp abnormalities in patients with trileaflet aortic valve and root aneurysm
Tristan Ehrlich1, Andreas Hagendorff2, Karen Abeln1
1Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg, Germany.
Heart (British Cardiac Society)
|July 8, 2022
Summary
Cusp prolapse is common in aortic root aneurysms, but two-dimensional trans-oesophageal echocardiography (2D TEE) often underdiagnoses it. This study evaluated 2D TEE
Area of Science:
- Cardiovascular Surgery
- Cardiac Imaging
- Aortic Valve Disease
Background:
- The prevalence of concurrent cusp pathology in patients with aortic root aneurysm, with or without aortic regurgitation, is not well-established.
- The diagnostic accuracy, including sensitivity and specificity, of two-dimensional trans-oesophageal echocardiography (2D TEE) for detecting concomitant cusp pathology remains undefined.
Purpose of the Study:
- To determine the frequency and types of cusp alterations in patients with aortic root aneurysm undergoing surgical intervention.
- To assess the sensitivity and specificity of 2D TEE in identifying these cusp alterations.
Main Methods:
- Analysis of cusp morphology in 582 patients with trileaflet aortic valves undergoing aortic root replacement.
- Retrospective analysis of intraoperative 2D TEE findings in 281 patients, correlated with intraoperative surgical observations.
Main Results:
- Cusp pathology was present in 90.9% of patients, with prolapse being the most frequent (n=473).
- 2D TEE demonstrated a sensitivity of 68.6% and specificity of 79.5% for detecting any cusp prolapse.
- The sensitivity of 2D TEE varied by cusp, being highest for the right coronary cusp.
Conclusions:
- Cusp prolapse is a frequent finding in aortic root aneurysms involving trileaflet aortic valves.
- Two-dimensional trans-oesophageal echocardiography frequently underdiagnoses cusp prolapse, as root dilatation can mask underlying cusp stretching.
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