Aortic Root Measurement by Cardiovascular Magnetic Resonance

Burman, Erik; Keegan, Jennifer; Kilner, Philip J.

doi:10.1161/circimaging.108.768911

Cited by 167 publications

(59 citation statements)

References 15 publications

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“…Root dimensions may be measured from cusp to cusp or from cusp to commissure, producing 3 diameters that are subsequently averaged. 23 The optimal definition for aortic root dilatation remains controversial. Normal aortic size is determined by age, sex, body size, location of the measurement, and robustness of the imaging modality.…”

Section: Discussionmentioning

confidence: 99%

Aortic Root Dilatation in Adults with Surgically Repaired Tetralogy of Fallot

et al. 2013

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Background— Although aortic root pathology has been described in patients with tetralogy of Fallot, the scope of the problem remains poorly defined. We sought to determine the prevalence and predictors of aortic root dilatation in adults with repaired tetralogy of Fallot. Methods and Results— A multicenter cross-sectional study was conducted with standardized reassessment of echocardiographic parameters in 474 adults (≥18 years) with surgically repaired tetralogy of Fallot or pulmonary atresia with ventricular septal defect. The aortic root was measured in a parasternal long-axis view, in diastole, at the level of the sinus of Valsalva. Prevalence and predictors of an absolute diameter ≥40 mm and of an observed-to-expected ratio >1.5 were assessed. The aortic root dimension was ≥40 mm in 28.9% (95% confidence interval, 26.9%–30.9%). In multivariate analyses, the only independently associated factor was male sex (odds ratio, 4.48; 95% confidence interval, 1.55–12.89; P =0.006). The prevalence of an observed-to-expected aortic root dimension ratio >1.5 was 6.6% (95% confidence interval, 5.3%–7.9%). It was associated with pulmonary atresia and moderate or severe aortic regurgitation in univariate analyses, but no independent predictor was identified. The side of the aortic arch was not associated with aortic root dimension. The prevalence of moderate or severe aortic regurgitation was 3.5% (95% confidence interval, 2.7%–4.2%). Conclusions— Although nearly one third of adults with repaired tetralogy of Fallot have an aortic root diameter ≥40 mm, the prevalence of a dilated aortic root, when defined by an indexed ratio of observed-to-expected values, is low. Similarly, moderate or severe aortic regurgitation is uncommon.

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Section: Discussionmentioning

confidence: 99%

Aortic Root Dilatation in Adults with Surgically Repaired Tetralogy of Fallot

et al. 2013

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“…2,4,18 However, with this imaging modality, the aortic valve annulus is assumed to be circular, although it has been demonstrated that this structure has an ellipsoid shape. 5,7 In this regard, Babaliaros et al 19 studied 23 patients with severe AS and demonstrated that transthoracic or transesophageal echocardiography underestimated the size of the aortic valve annulus by .1.7 and .1.2 mm, respectively, when compared with the measurement performed intraoperatively with surgical sizers. 19 The authors addressed the ellipsoid shape of the aortic valve annulus, and not an inaccuracy of this two-dimensional imaging technique, as the main cause of these differences.…”

Section: Discussionmentioning

confidence: 99%

Transcatheter aortic valve implantation: role of multi-detector row computed tomography to evaluate prosthesis positioning and deployment in relation to valve function

Delgado

Veire

et al. 2010

European Heart Journal

225

141

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“…13 Aortic measurements were obtained at the following 5 levels (Figure 1): neoaortic root, mid-AAo, distal transverse arch, isthmus, and descending aorta at the level of the diaphragm. Each aortic segment was reformatted in a double oblique plane, and 2 orthogonal measurements were recorded at each level as described by Kaiser et al 14 The aortic root was measured from sinus-to-commissure in one dimension (labeled as anteroposterior [AP]) and cusp-to-cusp in the other (labeled as lateral dimension) according to the method of Burman et al 15 The pulmonary arteries were similarly measured as described by Knobel et al 16 Body surface area (BSA) at the time of CMR was calculated from the patient height and weight using the method of Haycock et al 17 Volumetric measurements were adjusted to BSA 1.3 , and linear measurements were indexed to BSA 0.5 . 18-20 z scores were calculated from published normal values.…”

Section: Cmr Measurementsmentioning

confidence: 99%

Cardiovascular Magnetic Resonance Findings Late After the Arterial Switch Operation

Shepard

Germanakis

White

et al. 2016

Circ: Cardiovascular Imaging

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Because the arterial switch operation (ASO) became the standard treatment for infants and children with D-loop transposition of the great arteries (TGA) in the early-to-mid 1980s, survival has improved with the majority of patients now reaching adulthood.1 Although late mortality is rare, complications involving the implanted coronary arteries, pulmonary arteries, and neoaortic valve and root are increasingly recognized as sources of morbidity.2,3 Although echocardiography is capable of providing much of the clinically relevant information for noninvasive assessment of most ASO patients during infancy and childhood, its ability to adequately assess the key anatomic and functional elements in older patients is hindered by deteriorating acoustic windows.4 Cardiovascular magnetic resonance (CMR) has been shown to be a robust imaging modality in adolescents and adult patients with a wide variety of congenital heart disease, including those after the ASO. 5,6 Specifically, unlike echocardiography, CMR is not hindered by body size and is considered a reliable technique for assessment of the great vessels, biventricular size and function, myocardial viability, and valve regurgitation. See Editorial by de Roos See Clinical PerspectiveAlthough CMR can provide comprehensive anatomic and functional assessment in ASO patients, relatively sparse information has been published to date, and the ranges of ventricular and arterial dimensions and functional parameters have not been characterized. The goal of the present study, therefore, was to describe the range of biventricular size and function, frequency and location of focal myocardial fibrosis evaluated by late gadolinium enhancement (LGE) imaging, spectrum of great vessel dimensions, and frequency and severity of neoaortic valve regurgitation (neo-AR) in a large cohort of ASO patients evaluated at our center. In addition, we sought to explore factors associated with left ventricular (LV) enlargement and dysfunction, as well as neo-AR.Background-Despite its robust diagnostic capabilities in adolescents and adult patients after the arterial switch operation, little information is available on the cardiovascular magnetic resonance findings in this population. Methods and Results-The cardiovascular magnetic resonance findings of 220 consecutive patients evaluated in our center were retrospectively reviewed (median age at cardiovascular magnetic resonance, 15.4 years; 66.8% male sex). Compared with published normal values, left and right ventricular end-diastolic volume z scores were mildly enlarged (0.48±1.76 and 0.33±1.5; P=0.0003 and 0.0038, respectively), with 26% of patients having left ventricular dilatation and 20% having right ventricular dilatation. Left ventricular dysfunction was present in 21.5% of patients (mild in most), and only 5.1% of patients had mild right ventricular dysfunction. Myocardial scar was found in 1.8% of patients. Dilatation of the neoaortic root was common (76%), and root z score increased at an average rate of 0.03 points per year. By multivar...

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Aortic Root Measurement by Cardiovascular Magnetic Resonance

Cited by 167 publications

References 15 publications

Aortic Root Dilatation in Adults with Surgically Repaired Tetralogy of Fallot

Aortic Root Dilatation in Adults with Surgically Repaired Tetralogy of Fallot

Transcatheter aortic valve implantation: role of multi-detector row computed tomography to evaluate prosthesis positioning and deployment in relation to valve function

Cardiovascular Magnetic Resonance Findings Late After the Arterial Switch Operation

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