Normative Aortic Valvar Measurements in Adults Using Cardiac Computed Tomography　― A Potential Guide to Further Sophisticate Aortic Valve-Sparing Surgery ―

Abstract

few quantitative data on the repair-oriented 3-dimensional anatomy of the aortic root are currently available, which impairs standardization of the surgical technique. 1,11 The aim of the present study is to measure the precise metrics of the normal aortic valve as the standard value for guiding successful surgical repair by using computed tomography. 15 Methods Study PopulationWe retrospectively analyzed the datasets obtained from 264 consecutive patients who underwent cardiac computed A ortic valve-sparing surgery has become one of the popular operational options for the primarily regurgitant valve and/or proximal aortic aneurysm over the last few decades. 1-5 Although outcomes of aortic valve-sparing surgery have improved, 6-8 there remain problems, including intraoperative conversion to aortic valve replacement or recurrence of aortic regurgitation. 9-11 As the aortic root anatomy is too complicated to accurately evaluate only with 2-dimensional methodology, 2,12,13 3-dimensional evaluation is necessary to reveal the underlying mechanism of the aortic regurgitation and to define the predictors of successful surgical repair. 11,12,14 However,

Aortic valve leaflet and root dimensions in normal tricuspid aortic valves: a computed tomography study

“…Similarly, asymmetry of the leaflet surface areas, intercommissural distances and sinus of Valsalva volumes was found in a computed tomography study by Yang DH et al 12 . In a completely symmetric aortic valve, all leaflet measurements would be identical, however the two anatomical facts, that annulus plane and commissural plane are not parallel and that left ventricular outflow is elliptical result in small differences in commissural heights, leaflet dimensions and angles 8 . Effective height, however, showed the least amount of asymmetry -on average only 6% (0.5 mm), which explains its importance in keeping the aortic valve competent.…”

Stereogram of the Living Heart, Lung, and Adjacent Structures

“…In 1838, Wheatstone published the concept of stereopsis and created the first stereoscope [ 12 ]. However, after 184 years, his discovery seems to be underutilized in clinical settings, despite the significant advancements in cardiac imaging examinations in the 21st century [ 1 , 2 , 3 , 4 , 5 , 41 ]. Despite the lack of depth perception, volume-rendered images displayed on the two-dimensional surface are deemed to be “three-dimensional” images in clinical settings.…”

“…Transcatheter treatment for valvar heart diseases [ 25 , 26 ] and valve-sparing surgery [ 27 , 28 ] are emerging fields related to valvar heart diseases. As any of the heart valves and their relationship with the surrounding structures are three-dimensionally complex [ 29 ], two-dimensional images are not intuitive, occasionally misleading [ 5 ], and insufficient for a comprehensive evaluation. In this regard, the preprocedural detailed assessment of valvar morphology using cardiac computed tomography is an attractive option [ 30 , 31 , 32 ] in cases involving preprocedural computed tomographic evaluation of coronary artery stenosis.…”

“…However, such experience-based and imagination-driven three-dimensional perceptions cannot always be communicated and recognition errors cannot be avoided. With rapid advancements in the recent decades, three-dimensional cardiovascular imaging has become a part of daily clinical practice, including three-dimensional echocardiography [ 1 , 2 ] and cardiac computed tomography [ 3 , 4 , 5 ]. However, owing to their two-dimensional display, these three-dimensional images cannot provide real depth perception.…”

Commentary: Aortic valve reconstruction: Embrace it and master it … for your patients' sake … and your future

“…Imaging has come a long way as shown by a recent article by Izawa and colleagues. 2 The modern concepts of aortic valve reconstruction have undergone continuous improvement over the years. Although there are multiple subtle technical differences among the different publications in the literature, there are fundamental concepts, which when adhered to, allow for a more standardized approach and a more durable outcome than ever before.…”