Aortic root and cusp configuration determine aortic valve function

Objective: Normalisation of aortic root and cusp configuration is a prerequisite for successful aortic valve repair (AVR). Using transthoracic echocardiography, we studied aortic root dimensions relative to body size in normal subjects and AVR patients. Methods: Aortic roots of healthy volunteers (n = 130, age 27.9 +/- 6.9 years) were examined for aortoventricular (AV), sinus (S), sinutubular-junction diameters (ST) and effective height (height difference between the AV plane and central coaptation point, eH) by transthoracic echocardiography. In 651 patients, after AVR residual aortic valve insufficiency (Al) and eH were determined. The relationships between eH versus root dimensions and eH versus residual Al were analysed by analysis of variance with Bonferroni post hoc testing. Results: Root dimensions correlated with each other and body size (r = 0.74-0.91) In addition, a correlation between AV (r = 0.73), sinus diameter (r = 0 76), body height (r = 0.77), body surface area (r = 0.81) and eH was found. After AVR, eH was 9.8 +/- 0.9 mm in 235 patients without postoperative Al, 9.4 +/- 1.1 mm in 370 with mild Al, 7.9 +/- 1.4 mm in 43 patients with moderate Al and 6 +/- 1 mm in three patients with severe Al. The difference in means of effective height between the groups was significant ( p < 0.005). Of 497 AVR patients with an eH >= 9 mm, 309 had no or trivial Al, 186 had mild Al and only two had moderate Al. Conclusions: Parameters of aortic root dimensions follow a seemingly constant pattern in humans of different sizes Effective height has a constant relationship to root dimensions and body size In AVR, normalisation of eH leads to a high probability of normal or near-normal aortic valve function. (C) 2010 European Association for Cardio-Thoracic Surgery Published by Elsevier B.V. All rights reserved.