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

作者：Sohmer Benjamin^*; Jafar Reza; Patel Prakash; Chamberland Marie Eve; Labrosse Michel R; Boodhwani Munir

来源：Journal of Cardiothoracic and Vascular Anesthesia, 2018, 32(1): 344-351.

DOI：10.1053/j.jvca.2017.08.043

• aortic valve
• ventriculo-aortic junction
• sinotubular junction
• aortic insufficiency
• cusp coaptation surface area
• 3-dimensional transesophageal echocardiography
• echocardiography

Objective: 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.
Design: Two-pronged, clinical and computational approach.
Setting: Single university hospital.
Participants: The study comprised 10 patients with known AI and 98 NE simulations of increasingly dilated human aortic roots.
Interventions: 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 Eh simulations.
Measurements and Main Results: In the 10 AI patients, regurgitant fraction (RF) increased with EROA (R-2 = 0.77, p = 0.0008); CoapSA decreased with RF (R-2 = 0.72, p = 0.0020); CoapSA decreased with EROA (R-2 = 0.71, p = 0.0021); and normalized CoapSA (CoapSA/[Ventriculo-Aortic Junction x Sinotubular Junction]) decreased with EROA (R-2 = 0.60, p = 0.0088). In the 98 FE, simulations, normalized CoapSA decreased with EROA (R-2 = 0.50, p = 0.0001).
Conclusions: 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.

• 出版日期2018-2