Eccentricity of Aortic Annulus and Distance of Origin of Left Main and Right Coronary Arteries from Adjacent Aortic Leaflets in Non-Stenotic Aortic Valves by TEE 3D Echocardiography

Author(s): Hakimeh Sadeghian, Arash Jalal Omidi, Arash Jalali, Parto Siavosh

To measure the size of the aortic Annulus (AN) and Left Ventricular Outflow Tract (LVOT) in different views and distance between right and left coronary ostia from aortic annulus by Transesophageal (TEE)3D echocardiography in patients with normal aortic valves.

Method: 31 patients (51.5% F) underwent TEE3D.Full-volume of aortic valve was saved by TEE3D.AN was measured in 3 planes: two orthogonal lines in short-axis plane (D1 & D2), sagittal (D3) and coronal (D4) planes,diameter of LVOT 5-10 mm below AN was measured in sagittal and coronal views (D5 & D6). Area and perimeter of AN were measured and the annulus according to area and perimeter was calculated. Distance of left main and RCA from aortic leaflets and length of left coronary cusp were measured. All measurements were done in mid-systole.

Results: Aortic annulus in sagittal (D3) is smaller than coronal (D4), mean difference=1.97mm, P=0. 002.In 50% of subjects, D4 was greater than D3 more than 1.9 mm. D3 and D4 are not significantly different with D5 and D6. D perimeter is equal to mean D1&D2 and D3&D4 and D area is equal to D3. Mean distance of left main and RCA ostia from AN is 14.2±2.97 and15.25±3.60 mm respectively.Mean length of left coronary cusp is 12.75±2.1 mm.

Conclusion: Aortic annulus is oval shape in normal aortic valves and is larger in coronal than sagittal view in most subjects, D perimeter is equal to mean aortic annulus. D LVOT is non-significantly smaller than the following annulus D. Distance of LM ostium from aortic annulus is longer than RCA,length of left coronary cusp is shorter than left main-annulus distance.