Anatomically Normal Aortic Valve Area in Relation to Age, Sex, Body Size, and Aortic Root Dimensions: A TEE Study

Area of Science:

• Cardiovascular imaging
• Echocardiography
• Cardiac structure and function

Background:

• Aortic valve area (AVA) is crucial for assessing aortic stenosis severity.
• Current reference values for normal AVA are poorly defined, limited by 2D echocardiography.
• Three-dimensional transesophageal echocardiography (3D TEE) offers improved AVA quantification.

Purpose of the Study:

• To characterize normal AVA using 3D TEE in patients without aortic valve or root disease.
• To investigate associations between AVA and age, sex, body surface area (BSA), and aortic root geometry.
• To determine the optimal method for indexing AVA for accurate stenosis assessment.

Main Methods:

• Retrospective analysis of 239 Japanese adults without cardiovascular disease.
• Quantification of anatomically normal AVA using 3D planimetry during early systole.
• Statistical analysis of AVA correlations with demographic and geometric parameters.

Main Results:

• Median AVA was 3.2 cm², significantly associated with age, sex, and BSA.
• AVA was smaller in women than men, declining with age in men but not women.
• Annular area showed the strongest correlation with AVA, outperforming BSA for explanatory power.

Conclusions:

• Annular area is a primary determinant of normal AVA.
• Indexing AVA to annular area, rather than BSA, may enhance the accuracy of aortic stenosis severity assessment.
• 3D TEE provides a more precise characterization of normal AVA.