Skip to main content
SpringerLink
Log in

The Normal Aortic Valve Complex

  • Chapter
  • First Online:
Textbook of Three-Dimensional Echocardiography

  • 1235 Accesses

Abstract

The aortic valve (AV) complex involves the left ventricular outflow tract (LVOT), aortic annulus, AV leaflets, and the aortic root (to the sinotubular junction). Three-dimensional imaging studies have advanced our current understanding of the AV anatomy. Acquisition protocols and standardized imaging planes allow for more accurate descriptions of anatomy.

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Messika-Zeitoun D, Serfaty JM, Brochet E, Ducrocq G, Lepage L, Detaint D, et al. Multimodal assessment of the aortic annulus diameter: implications for transcatheter aortic valve implantation. J Am Coll Cardiol. 2010;55(3):186–94.

    Article  Google Scholar 

  2. Altiok E, Koos R, Schroder J, Brehmer K, Hamada S, Becker M, et al. Comparison of two-dimensional and three-dimensional imaging techniques for measurement of aortic annulus diameters before transcatheter aortic valve implantation. Heart. 2011;97(19):1578–84.

    Article  Google Scholar 

  3. Gurvitch R, Webb JG, Yuan R, Johnson M, Hague C, Willson AB, et al. Aortic annulus diameter determination by multidetector computed tomography: reproducibility, applicability, and implications for transcatheter aortic valve implantation. JACC Cardiovasc Interv. 2011;4(11):1235–45.

    Article  Google Scholar 

  4. Tzikas A, Schultz CJ, Piazza N, Moelker A, Van Mieghem NM, Nuis RJ, et al. Assessment of the aortic annulus by multislice computed tomography, contrast aortography, and trans-thoracic echocardiography in patients referred for transcatheter aortic valve implantation. Catheter Cardiovasc Interv. 2011;77(6):868–75.

    Article  Google Scholar 

  5. Gaspar T, Adawi S, Sachner R, Asmer I, Ganaeem M, Rubinshtein R, et al. Three-dimensional imaging of the left ventricular outflow tract: impact on aortic valve area estimation by the continuity equation. J Am Soc Echocardiogr. 2012;25(7):749–57.

    Article  Google Scholar 

  6. Saitoh T, Shiota M, Izumo M, Gurudevan SV, Tolstrup K, Siegel RJ, et al. Comparison of left ventricular outflow geometry and aortic valve area in patients with aortic stenosis by 2-dimensional versus 3-dimensional echocardiography. Am J Cardiol. 2012;109(11):1626–31.

    Article  Google Scholar 

  7. Hamdan A, Guetta V, Konen E, Goitein O, Segev A, Raanani E, et al. Deformation dynamics and mechanical properties of the aortic annulus by 4-dimensional computed tomography insights into the functional anatomy of the aortic valve complex and implications for transcatheter aortic valve therapy. J Am Coll Cardiol. 2012;59(2):119–27.

    Article  Google Scholar 

  8. Akhtar M, Tuzcu EM, Kapadia SR, Svensson LG, Greenberg RK, Roselli EE, et al. Aortic root morphology in patients undergoing percutaneous aortic valve replacement: evidence of aortic root remodeling. J Thorac Cardiovasc Surg. 2009;137(4):950–6.

    Article  Google Scholar 

  9. Buellesfeld L, Stortecky S, Kalesan B, Gloekler S, Khattab AA, Nietlispach F, et al. Aortic root dimensions among patients with severe aortic stenosis undergoing transcatheter aortic valve replacement. JACC Cardiovasc Interv. 2013;6(1):72–83.

    Article  Google Scholar 

  10. Ewe SH, Ng AC, Schuijf JD, van der Kley F, Colli A, Palmen M, et al. Location and severity of aortic valve calcium and implications for aortic regurgitation after transcatheter aortic valve implantation. Am J Cardiol. 2011;108(10):1470–7.

    Article  CAS  Google Scholar 

  11. Colli A, D’Amico R, Kempfert J, Borger MA, Mohr FW, Walther T. Transesophageal echocardiographic scoring for transcatheter aortic valve implantation: impact of aortic cusp calcification on postoperative aortic regurgitation. J Thorac Cardiovasc Surg. 2011;142(5):1229–35.

    Article  Google Scholar 

  12. Goland S, Trento A, Iida K, Czer LS, De Robertis M, Naqvi TZ, et al. Assessment of aortic stenosis by three-dimensional echocardiography: an accurate and novel approach. Heart. 2007;93(7):801–7.

    Article  Google Scholar 

  13. Doddamani S, Bello R, Friedman MA, Banerjee A, Bowers JH Jr, Kim B, et al. Demonstration of left ventricular outflow tract eccentricity by real time 3D echocardiography: implications for the determination of aortic valve area. Echocardiography. 2007;24(8):860–6.

    Article  Google Scholar 

  14. Shahgaldi K, Manouras A, Brodin LA, Winter R. Direct measurement of left ventricular outflow tract area using three-dimensional echocardiography in biplane mode improves accuracy of stroke volume assessment. Echocardiography. 2010;27(9):1078–85.

    Article  Google Scholar 

  15. Jilaihawi H, Doctor N, Kashif M, Chakravarty T, Rafique A, Makar M, et al. Aortic annular sizing for transcatheter aortic valve replacement using cross-sectional 3-dimensional transesophageal echocardiography. J Am Coll Cardiol. 2013;61(9):908–16.

    Article  Google Scholar 

  16. Khalique OK, Kodali SK, Paradis JM, Nazif TM, Williams MR, Einstein AJ, et al. Aortic annular sizing using a novel 3-dimensional echocardiographic method: use and comparison with cardiac computed tomography. Circ Cardiovasc Imaging. 2014;7(1):155–63.

    Article  Google Scholar 

  17. Anderson RH. Clinical anatomy of the aortic root. Heart. 2000;84(6):670–3.

    Article  CAS  Google Scholar 

  18. Piazza N, de Jaegere P, Schultz C, Becker AE, Serruys PW, Anderson RH. Anatomy of the aortic valvar complex and its implications for transcatheter implantation of the aortic valve. Circ Cardiovasc Interv. 2008;1(1):74–81.

    Article  Google Scholar 

  19. Brewer RJ, Deck JD, Capati B, Nolan SP. The dynamic aortic root. Its role in aortic valve functon. J Thorac Cardiovasc Surg. 1976;72:413–7.

    CAS  PubMed  Google Scholar 

  20. Otani K, Takeuchi M, Kaku K, Sugeng L, Yoshitani H, Haruki N, et al. Assessment of the aortic root using real-time 3D transesophageal echocardiography. Circ J. 2010;74(12):2649–57.

    Article  Google Scholar 

  21. Mori Y, Shiota T, Jones M, Wanitkun S, Irvine T, Li X, et al. Three-dimensional reconstruction of the color Doppler-imaged vena contracta for quantifying aortic regurgitation: studies in a chronic animal model. Circulation. 1999;99(12):1611–7.

    Article  CAS  Google Scholar 

  22. Fang L, Hsiung MC, Miller AP, Nanda NC, Yin WH, Young MS, et al. Assessment of aortic regurgitation by live three-dimensional transthoracic echocardiographic measurements of vena contracta area: usefulness and validation. Echocardiography. 2005;22(9):775–81.

    Article  Google Scholar 

  23. Perez de Isla L, Zamorano J, Fernandez-Golfin C, Ciocarelli S, Corros C, Sanchez T, et al. 3D color-Doppler echocardiography and chronic aortic regurgitation: a novel approach for severity assessment. Int J Cardiol. 2013;166(3):640–5.

    Article  Google Scholar 

  24. Chen TE, Kwon SH, Enriquez-Sarano M, Wong BF, Mankad SV. Three-dimensional color Doppler echocardiographic quantification of tricuspid regurgitation orifice area: comparison with conventional two-dimensional measures. J Am Soc Echocardiogr. 2013;26(10):1143–52.

    Article  Google Scholar 

  25. Franco E, Almeria C, de Agustin JA, Arreo Del Val V, Gomez de Diego JJ, Garcia Fernandez MA, et al. Three-dimensional color Doppler transesophageal echocardiography for mitral paravalvular leak quantification and evaluation of percutaneous closure success. J Am Soc Echocardiogr. 2014;27(11):1153–63.

    Article  Google Scholar 

  26. Altiok E, Hamada S, Brehmer K, Kuhr K, Reith S, Becker M, et al. Analysis of procedural effects of percutaneous edge-to-edge mitral valve repair by 2D and 3D echocardiography. Circ Cardiovasc Imaging. 2012;5(6):748–55.

    Article  Google Scholar 

  27. Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA, et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr. 2003;16(7):777–802.

    Article  Google Scholar 

  28. Pirat B, Little SH, Igo SR, McCulloch M, Nose Y, Hartley CJ, et al. Direct measurement of proximal isovelocity surface area by real-time three-dimensional color Doppler for quantitation of aortic regurgitant volume: an in vitro validation. J Am Soc Echocardiogr. 2009;22(3):306–13.

    Article  Google Scholar 

  29. Little SH, Igo SR, Pirat B, McCulloch M, Hartley CJ, Nose Y, et al. In vitro validation of real-time three-dimensional color Doppler echocardiography for direct measurement of proximal isovelocity surface area in mitral regurgitation. Am J Cardiol. 2007;99(10):1440–7.

    Article  Google Scholar 

  30. de Agustin JA, Marcos-Alberca P, Fernandez-Golfin C, Goncalves A, Feltes G, Nunez-Gil IJ, et al. Direct measurement of proximal isovelocity surface area by single-beat three-dimensional color Doppler echocardiography in mitral regurgitation: a validation study. J Am Soc Echocardiogr. 2012;25(8):815–23.

    Article  Google Scholar 

  31. de Agustin JA, Viliani D, Vieira C, Islas F, Marcos-Alberca P, Gomez de Diego JJ, et al. Proximal isovelocity surface area by single-beat three-dimensional color Doppler echocardiography applied for tricuspid regurgitation quantification. J Am Soc Echocardiogr. 2013;26(9):1063–72.

    Article  Google Scholar 

  32. Li C, Zhang J, Li X, Zhou C, Li H, Tang H, et al. Quantification of chronic aortic regurgitation by vector flow mapping: a novel echocardiographic method. Eur J Echocardiogr. 2010;11(2):119–24.

    Article  Google Scholar 

  33. Little SH, Igo SR, McCulloch M, Hartley CJ, Nose Y, Zoghbi WA. Three-dimensional ultrasound imaging model of mitral valve regurgitation: design and evaluation. Ultrasound Med Biol. 2008;34(4):647–54.

    Article  Google Scholar 

  34. Thavendiranathan P, Liu S, Datta S, Walls M, Nitinunu A, Van Houten T, et al. Automated quantification of mitral inflow and aortic outflow stroke volumes by three-dimensional real-time volume color-flow Doppler transthoracic echocardiography: comparison with pulsed-wave Doppler and cardiac magnetic resonance imaging. J Am Soc Echocardiogr. 2012;25(1):56–65.

    Article  Google Scholar 

  35. Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP, et al. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. J Am Soc Echocardiogr. 2009;22(1):1–23; quiz 101–2.

    Article  Google Scholar 

  36. De Vecchi C, Caudron J, Dubourg B, Pirot N, Lefebvre V, Bauer F, et al. Effect of the ellipsoid shape of the left ventricular outflow tract on the echocardiographic assessment of aortic valve area in aortic stenosis. J Cardiovasc Comput Tomogr. 2014;8(1):52–7.

    Article  Google Scholar 

  37. Burgstahler C, Kunze M, Loffler C, Gawaz MP, Hombach V, Merkle N. Assessment of left ventricular outflow tract geometry in non-stenotic and stenotic aortic valves by cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2006;8(6):825–9.

    Article  Google Scholar 

  38. Halpern EJ, Mallya R, Sewell M, Shulman M, Zwas DR. Differences in aortic valve area measured with CT planimetry and echocardiography (continuity equation) are related to divergent estimates of left ventricular outflow tract area. AJR Am J Roentgenol. 2009;192(6):1668–73.

    Article  Google Scholar 

  39. O’Brien B, Schoenhagen P, Kapadia SR, Svensson LG, Rodriguez L, Griffin BP, et al. Integration of 3D imaging data in the assessment of aortic stenosis: impact on classification of disease severity. Circ Cardiovasc Imaging. 2011;4(5):566–73.

    Article  Google Scholar 

  40. Montealegre-Gallegos M, Mahmood F, Owais K, Hess P, Jainandunsing JS, Matyal R. Cardiac output calculation and three-dimensional echocardiography. J Cardiothorac Vasc Anesth. 2014;28(3):547–50.

    Article  Google Scholar 

  41. Tsang W, Bateman MG, Weinert L, Pellegrini G, Mor-Avi V, Sugeng L, et al. Accuracy of aortic annular measurements obtained from three-dimensional echocardiography, CT and MRI: human in vitro and in vivo studies. Heart. 2012;98(15):1146–52.

    Article  Google Scholar 

  42. Clavel MA, Malouf J, Messika-Zeitoun D, Araoz PA, Michelena HI, Enriquez-Sarano M. Aortic valve area calculation in aortic stenosis by CT and Doppler echocardiography. JACC Cardiovasc Imaging. 2015;8(3):248–57.

    Article  Google Scholar 

  43. Malouf J, Le Tourneau T, Pellikka P, Sundt TM, Scott C, Schaff HV, et al. Aortic valve stenosis in community medical practice: determinants of outcome and implications for aortic valve replacement. J Thorac Cardiovasc Surg. 2012;144(6):1421–7.

    Article  Google Scholar 

  44. Nishimura RA, Otto C. 2014 ACC/AHA valve guidelines: earlier intervention for chronic mitral regurgitation. Heart. 2014;100(12):905–7.

    Article  Google Scholar 

  45. Koos R, Altiok E, Mahnken AH, Neizel M, Dohmen G, Marx N, et al. Evaluation of aortic root for definition of prosthesis size by magnetic resonance imaging and cardiac computed tomography: implications for transcatheter aortic valve implantation. Int J Cardiol. 2012;158(3):353–8.

    Article  Google Scholar 

  46. Murphy DT, Blanke P, Alaamri S, Naoum C, Rubinshtein R, Pache G, et al. Dynamism of the aortic annulus: effect of diastolic versus systolic CT annular measurements on device selection in transcatheter aortic valve replacement (TAVR). J Cardiovasc Comput Tomogr. 2016;10(1):37–43.

    Article  Google Scholar 

  47. Willson AB, Webb JG, Labounty TM, Achenbach S, Moss R, Wheeler M, et al. 3-dimensional aortic annular assessment by multidetector computed tomography predicts moderate or severe paravalvular regurgitation after transcatheter aortic valve replacement: a multicenter retrospective analysis. J Am Coll Cardiol. 2012;59(14):1287–94.

    Article  Google Scholar 

  48. Jilaihawi H, Kashif M, Fontana G, Furugen A, Shiota T, Friede G, et al. Cross-sectional computed tomographic assessment improves accuracy of aortic annular sizing for transcatheter aortic valve replacement and reduces the incidence of paravalvular aortic regurgitation. J Am Coll Cardiol. 2012;59(14):1275–86.

    Article  Google Scholar 

  49. Hahn RT, Khalique O, Williams MR, Koss E, Paradis JM, Daneault B, et al. Predicting paravalvular regurgitation following transcatheter valve replacement: utility of a novel method for three-dimensional echocardiographic measurements of the aortic annulus. J Am Soc Echocardiogr. 2013;26(9):1043–52.

    Article  Google Scholar 

  50. Santos N, de Agustin JA, Almeria C, Goncalves A, Marcos-Alberca P, Fernandez-Golfin C, et al. Prosthesis/annulus discongruence assessed by three-dimensional transoesophageal echocardiography: a predictor of significant paravalvular aortic regurgitation after transcatheter aortic valve implantation. Eur Heart J Cardiovasc Imaging. 2012;13(11):931–7.

    Article  Google Scholar 

  51. Janosi RA, Kahlert P, Plicht B, Wendt D, Eggebrecht H, Erbel R, et al. Measurement of the aortic annulus size by real-time three-dimensional transesophageal echocardiography. Minim Invasive Ther Allied Technol. 2011;20(2):85–94.

    Article  Google Scholar 

  52. Gripari P, Ewe SH, Fusini L, Muratori M, Ng AC, Cefalu C, et al. Intraoperative 2D and 3D transoesophageal echocardiographic predictors of aortic regurgitation after transcatheter aortic valve implantation. Heart. 2012;98(16):1229–36.

    Article  Google Scholar 

  53. Smith LA, Dworakowski R, Bhan A, Delithanasis I, Hancock J, Maccarthy PA, et al. Real-time three-dimensional transesophageal echocardiography adds value to transcatheter aortic valve implantation. J Am Soc Echocardiogr. 2013;26(4):359–69.

    Article  Google Scholar 

  54. Kasel AM, Cassese S, Bleiziffer S, Amaki M, Hahn RT, Kastrati A, et al. Standardized imaging for aortic annular sizing: implications for transcatheter valve selection. JACC Cardiovasc Imaging. 2013;6(2):249–62.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiology/Structural Heart and Valve Center, Columbia University Medical Center, New York, NY, USA

    Rebecca T. Hahn

Authors
  1. Rebecca T. Hahn
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rebecca T. Hahn .

Editor information

Editors and Affiliations

  1. University of Milano-Bicocca and Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milano, Italy

    Luigi P. Badano

  2. Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA

    Roberto M. Lang

  3. University of Milano-Bicocca and Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milano, Italy

    Denisa Muraru

Electronic Supplementary Material

Zoom acquisition of the aortic valve by transesophageal three-dimensional echocardiography (AVI 2178 kb)

Volume rendering of the aortic complex with the left main coronary ostia (white arrow) (AVI 3046 kb)

Volume rendering of the aortic valve seen from the aortic perspective (AVI 9562 kb)

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Hahn, R.T. (2019). The Normal Aortic Valve Complex. In: Badano, L., Lang, R., Muraru, D. (eds) Textbook of Three-Dimensional Echocardiography. Springer, Cham. https://doi.org/10.1007/978-3-030-14032-8_12

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-14032-8_12

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-14030-4

  • Online ISBN: 978-3-030-14032-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation