Preoperative Eccentric Aortic Regurgitation and Outcomes Following Valve-Sparing Root Replacement

Abnormal Color Flow Jet in Left Ventricular Outflow Tract Mimicking a Ventricular Septal Defect: Establishing Differentials and Diagnosis and Role of Transesophageal Echocardiography

“…All standard 2D (2-dimensional) views for AV should first be used, carefully inspecting for calcifications, fenestrations, perforations, free margin elongation, or prominence. 10 In our case, as the eccentric jet was in the…”

“…Eccentric AI can be multifactorial, often related to asymmetry involving 1 or more cusps or abnormal aortic root geometry. 10 Park et al 11 concluded in their comparison of eccentric versus central AI that in patients with TV AVs associated with eccentric AI, 63% of the valves demonstrated asymmetry. Arora and Maddali 12 described a case of a localized eccentric AI jet secondary to AV intercusp size discrepancy with a resultant coaptation defect, which mimicked a cusp perforation or fenestration.…”

“…All standard 2D (2-dimensional) views for AV should first be used, carefully inspecting for calcifications, fenestrations, perforations, free margin elongation, or prominence. 10 In our case, as the eccentric jet was in the LVOT and potentially originating from the AV, we used ME-SAX, ME-LAX, TG-LAX, and deep TG views. Color flow Doppler (CFD) along with 2D echocardiography determines the nature of the pathology, as well as the direction and degree of the jet.…”

Valve-sparing root replacement—reimplantation technique

“…When examining the impact of preoperative jet centricity in patients with >2+ preoperative AI, preoperative eccentric AI did not negatively impact operative outcomes when compared to preoperative central AI (30 d mortality 0% vs. 4%, eccentric vs. concentric, P=0.64). When comparing long-term outcomes, ten-year cumulative incidence of aortic valve replacement (AVR) (93% vs. 100%, P=0.98) and ten-year freedom from >1+ AI (15% vs. 0%, P=0.97) were similar between patients with preoperative eccentric AI compared to those with preoperative central AI ( 10 ).…”