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Aortic Valve Cusp Coaptation Surface Area Using 3-Dimensional Transesophageal Echocardiography Correlates with Severity of Aortic Valve Insufficiency. 2018

Benjamin Sohmer, and Reza Jafar, and Prakash Patel, and Marie-Ève Chamberland, and Michel R Labrosse, and Munir Boodhwani
Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. Electronic address: bsohmer@ottawaheart.ca.

The aim of this study was to test both in humans and using finite element (FE) aortic valve (AV) models whether the coaptation surface area (CoapSA) correlates with aortic insufficiency (AI) severity due to dilated aortic roots to determine the validity and utility of 3-dimensional transesophageal echocardiographic-measured CoapSA. Two-pronged, clinical and computational approach. Single university hospital. The study comprised 10 patients with known AI and 98 FE simulations of increasingly dilated human aortic roots. The CoapSA was calculated using intraoperative 3-dimensional transesophageal echocardiography data of patients with isolated AI and compared with established quantifiers of AI. In addition, the CoapSA and effective regurgitant orifice area (EROA) were determined using FE simulations. In the 10 AI patients, regurgitant fraction (RF) increased with EROA (R2 = 0.77, p = 0.0008); CoapSA decreased with RF (R2 = 0.72, p = 0.0020); CoapSA decreased with EROA (R2 = 0.71, p = 0.0021); and normalized CoapSA (CoapSA / [Ventriculo-Aortic Junction × Sinotubular Junction]) decreased with EROA (R2 = 0.60, p = 0.0088). In the 98 FE simulations, normalized CoapSA decreased with EROA (R2 = 0.50, p = 0.0001). In both human and FE AV models, CoapSA was observed to be inversely correlated with AI severity, EROA, and RF, thereby supporting the validity and utility of 3D TEE-measured CoapSA. A clinical implication is the expectation that high values of CoapSA, measured intraoperatively after AV repairs, would correlate with better long-term outcomes of those repairs.

UI MeSH Term Description Entries
D008297 Male Males
D003198 Computer Simulation Computer-based representation of physical systems and phenomena such as chemical processes. Computational Modeling,Computational Modelling,Computer Models,In silico Modeling,In silico Models,In silico Simulation,Models, Computer,Computerized Models,Computer Model,Computer Simulations,Computerized Model,In silico Model,Model, Computer,Model, Computerized,Model, In silico,Modeling, Computational,Modeling, In silico,Modelling, Computational,Simulation, Computer,Simulation, In silico,Simulations, Computer
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D001021 Aortic Valve The valve between the left ventricle and the ascending aorta which prevents backflow into the left ventricle. Aortic Valves,Valve, Aortic,Valves, Aortic
D001022 Aortic Valve Insufficiency Pathological condition characterized by the backflow of blood from the ASCENDING AORTA back into the LEFT VENTRICLE, leading to regurgitation. It is caused by diseases of the AORTIC VALVE or its surrounding tissue (aortic root). Aortic Incompetence,Aortic Regurgitation,Aortic Valve Incompetence,Regurgitation, Aortic Valve,Incompetence, Aortic,Incompetence, Aortic Valve,Insufficiency, Aortic Valve,Regurgitation, Aortic
D012720 Severity of Illness Index Levels within a diagnostic group which are established by various measurement criteria applied to the seriousness of a patient's disorder. Illness Index Severities,Illness Index Severity
D016343 Monitoring, Intraoperative The constant checking on the state or condition of a patient during the course of a surgical operation (e.g., checking of vital signs). Intraoperative Monitoring
D017548 Echocardiography, Transesophageal Ultrasonic recording of the size, motion, and composition of the heart and surrounding tissues using a transducer placed in the esophagus. Transesophageal Echocardiography
D019560 Echocardiography, Three-Dimensional Echocardiography amplified by the addition of depth to the conventional two-dimensional ECHOCARDIOGRAPHY visualizing only the length and width of the heart. Three-dimensional ultrasound imaging was first described in 1961 but its application to echocardiography did not take place until 1974. (Mayo Clin Proc 1993;68:221-40) 3-D Echocardiography,3D Echocardiography,Echocardiography, 3-D,Echocardiography, 3D,Three-Dimensional Echocardiography,3 D Echocardiography,3-D Echocardiographies,3D Echocardiographies,Echocardiographies, 3-D,Echocardiographies, 3D,Echocardiographies, Three-Dimensional,Echocardiography, 3 D,Echocardiography, Three Dimensional,Three Dimensional Echocardiography,Three-Dimensional Echocardiographies

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