Skip to main content
SpringerLink
Log in

Quantitative measurements of aortic valve coaptation by three-dimensional transesophageal echocardiography in patients with aortic regurgitation without primary leaflet disease

  • Original Investigation
  • Published:
Journal of Echocardiography Aims and scope Submit manuscript

Abstract

Background

Aortic regurgitation (AR) without primary leaflet disease (functional AR) is known to occur as a result of loss of coaptation due to sinotubular junction (STJ) dilatation. However, the characteristics of change in the aortic valve coaptation length (AVCL) in 3 cusps in patients with functional AR are, as yet, unclear. The aim of this study was to measure the AVCL in 3 cusps in patients with functional AR by three-dimensional transesophageal echocardiograph (3D TEE).

Methods and results

Thirteen patients with functional AR with or without aortic dilatation (trivial to mild AR [group A] and moderate to severe AR [group B]) and 7 controls without AR (group N) were examined. We measured the AVCL between the left coronary cusp (LCC) and right coronary cusp (RCC), the LCC and non coronary cusp (NCC), the RCC and NCC, and we also measured the cusp projection area, STJ arc length, leaflet tip–Valsalva wall distance and inter-commissural distance in each cusp by 3D TEE. The average AVCL was significantly shorter in group B than in groups N and A (P < 0.001). Particularly, in group B, there was a significant difference in AVCL in the 3 cusps (P = 0.043). Moreover, although there were no significant differences in the size of cusps in groups N and A, there was disproportion in the size of those cusps in group B with the largest in RCC.

Conclusion

Cusp enlargement was not uniform and was greatest in the RCC, and the loss of coaptation between the 3 cusps was also not uniform, with predominant reduction in the coaptation between the RCC and the other 2 cusps.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Furukawa K, Ohteki H, Cao ZL, Doi K, Narita Y, Minato N, et al. Does dilatation of the sinotubular junction cause aortic regurgitation? Ann Thorac Surg. 1999;68:949–54.

    Article  CAS  PubMed  Google Scholar 

  2. Frazin L, Talano JV, Stephanides L, Loeb HS, Kopel L, Gunnar RM. Esophageal echocardiography. Circulation. 1976;54:102–8.

    CAS  PubMed  Google Scholar 

  3. Pearlman AS, Gardin JM, Martin RP, Parisi AF, Popp RL, Quinones MA, et al. Guidelines for physician training in transesophageal echocardiography: recommendations of the American Society of Echocardiography Committee for Physician Training in Echocardiography. J Am Soc Echocardiogr. 1992;5:187–94.

    CAS  PubMed  Google Scholar 

  4. Seward JB, Khandheria BK, Oh JK, Abel MD, Hughes RW Jr, Edwards WD, et al. Transesophageal echocardiography: technique, anatomic correlations, implementation, and clinical applications. Mayo Clin Proc. 1988;63:649–80.

    CAS  PubMed  Google Scholar 

  5. Daniel WG, Erbel R, Kasper W, Visser CA, Engberding R, Sutherland GR, et al. Safety of transesophageal echocardiography. A multicenter survey of 10,419 examinations. Circulation. 1991;83:817–21.

    CAS  PubMed  Google Scholar 

  6. Watanabe N, Ogasawara Y, Yamaura Y, Kawamoto T, Toyota E, Akasaka T, et al. Quantitation of mitral valve tenting in ischemic mitral regurgitation by transthoracic real-time three-dimensional echocardiography. J Am Coll Cardiol. 2005;45:763–9.

    Article  PubMed  Google Scholar 

  7. Watanabe N, Ogasawara Y, Yamaura Y, Wada N, Kawamoto T, Toyota E, et al. Mitral annulus flattens in ischemic mitral regurgitation: geometric differences between inferior and anterior myocardial infarction: a real-time 3-dimensional echocardiographic study. Circulation. 2005;112:I458–62.

    Article  PubMed  CAS  Google Scholar 

  8. Yamaura Y, Watanabe N, Ogasawara Y, Wada N, Kawamoto T, Toyota E, et al. Geometric change of mitral valve leaflets and annulus after reconstructive surgery for ischemic mitral regurgitation: real-time 3-dimensional echocardiographic study. J Thorac Cardiovasc Surg. 2005;130:1459–61.

    Article  PubMed  Google Scholar 

  9. Watanabe N, Ogasawara Y, Saito K, Yamaura Y, Tsukiji M, Okahashi N, et al. Quantitation of the degree of mitral valve prolapse by novel software system: new insights from transthoracic real-time three-dimensional echocardiography. J Echocardiogr. 2007;4:112–7.

    Article  Google Scholar 

  10. Handke M, Jahnke C, Heinrichs G, Schlegel J, Vos C, Schmitt D, et al. New three-dimensional echocardiographic system using digital radiofrequency data—visualization and quantitative analysis of aortic valve dynamics with high resolution: methods, feasibility, and initial clinical experience. Circulation. 2003;107:2876–9.

    Article  PubMed  Google Scholar 

  11. Sato Y, Kamata J, Izumoto H, Nasu M, Kawazoe K. Morphological analysis of aortic root in eccentric aortic regurgitation using anyplane two-dimensional images produced by transesophageal three-dimensional echocardiography. J Heart Valve Dis. 2003;12:186–96.

    PubMed  Google Scholar 

  12. Shim CY, Watanabe N, Tsukiji M, Yamaura Y, Ogasawara Y, Ha JW, et al. Three-dimensional geometry of aortic valve: a new trial of visualization with real-time three-dimensional echocardiography. J Echocardiogr. 2007;5:55–7.

    Article  Google Scholar 

  13. Lang RM, Mor-Avi V, Sugeng L, Nieman PS, Sahn DJ. Three-dimensional echocardiography: the benefits of the additional dimension. J Am Coll Cardiol. 2006;48:2053–69.

    Article  PubMed  Google Scholar 

  14. Mercer JL, Benedicty M, Bahnson HT. The geometry and construction of the aortic leaflet. J Thorac Cardiovasc Surg. 1973;65:511–8.

    CAS  PubMed  Google Scholar 

  15. Swanson M, Clark RE. Dimensions and geometric relationships of the human aortic valve as a function of pressure. Circ Res. 1974;35:871–82.

    CAS  PubMed  Google Scholar 

  16. Perry GJ, Helmcke F, Nanda NC, Byard C, Soto B. Evaluation of aortic insufficiency by Doppler color flow mapping. J Am Coll Cardiol. 1987;9:952–9.

    Article  CAS  PubMed  Google Scholar 

  17. Dolan MS, Castello R, St Vrain JA, Aguirre F, Labovitz AJ. Quantitation of aortic regurgitation by Doppler echocardiography: a practical approach. Am Heart J. 1995;129:1014–20.

    Article  CAS  PubMed  Google Scholar 

  18. Vandervoort PM, Rivera JM, Mele D, Palacios IF, Dinsmore RE, Weyman AE, et al. Application of color Doppler flow mapping to calculate effective regurgitant orifice area. An in vitro study and initial clinical observations. Circulation. 1993;88:1150–6.

    CAS  PubMed  Google Scholar 

  19. Bellhouse BJ, Bellhouse F, Abbott JA, Talbot L. Mechanism of valvular incompetence in aortic sinus dilatation. Cardiovasc Res. 1973;7:490–4.

    Article  CAS  PubMed  Google Scholar 

  20. Padial LR, Oliver A, Sagie A, Weyman AE, King ME, Levine RA. Two-dimensional echocardiographic assessment of the progression of aortic root size in 127 patients with chronic aortic regurgitation: role of the supraaortic ridge and relation to the progression of the lesion. Am Heart J. 1997;134:814–21.

    Article  CAS  PubMed  Google Scholar 

  21. Vasan RS, Larson MG, Levy D. Determinants of echocardiographic aortic root size. The Framingham Heart Study. Circulation. 1995;91:734–40.

    CAS  PubMed  Google Scholar 

  22. Seder JD, Burke JF, Pauletto FJ. Prevalence of aortic regurgitation by color flow Doppler in relation to aortic root size. J Am Soc Echocardiogr. 1990;3:316–9.

    CAS  PubMed  Google Scholar 

  23. Farasat SM, Morrell CH, Scuteri A, Ting CT, Yin FCP, Spurgeon HA, et al. Do hypertensive individuals have enlarged aortic root diameters? Insights from studying the various subtypes of hypertension. Am J Hypertens. 2008;21:558–63.

    Article  PubMed  Google Scholar 

  24. Edwards WD. Cardiac anatomy and examination of cardiac specimens. In: Emmanouilides G, Riemenschneider T, Allen H, Gutgesell H, editors. Moss & Adams’ heart disease in infants, children, and adolescents. 5th ed. Baltimore: Williams & Wilkins; 1995. pp. 70–105.

    Google Scholar 

  25. Minakata K, Schaff HV, Zehr KJ, Dearani JA, Daly RC, Orszulak TA, et al. Is repair of aortic valve regurgitation a safe alternative to valve replacement? J Thorac Cardiovasc Surg. 2004;127:645–53.

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

We would like to thank Mariko Mimura for the English language support.

Conflict of interest statement

None declared.

Author information

Authors and Affiliations

  1. Department of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan

    Koichiro Imai, Nozomi Watanabe, Ken Saito, Akihiro Hayashida, Tomoko Maehama, Yoshinori Miyamoto, Takahiro Kawamoto, Yoji Neishi, Hiroyuki Okura & Kiyoshi Yoshida

Authors
  1. Koichiro Imai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nozomi Watanabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ken Saito
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Akihiro Hayashida
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tomoko Maehama
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yoshinori Miyamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Takahiro Kawamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yoji Neishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hiroyuki Okura
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Kiyoshi Yoshida
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Koichiro Imai.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Imai, K., Watanabe, N., Saito, K. et al. Quantitative measurements of aortic valve coaptation by three-dimensional transesophageal echocardiography in patients with aortic regurgitation without primary leaflet disease. J Echocardiogr 8, 7–13 (2010). https://doi.org/10.1007/s12574-009-0028-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12574-009-0028-y

Keywords

Search

Navigation