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

Benjamin Sohmer; Reza Jafar; Prakash Patel; Marie-Ève Chamberland; Michel R Labrosse; Munir Boodhwani

doi:10.1053/j.jvca.2017.08.043

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

J Cardiothorac Vasc Anesth. 2018 Feb;32(1):344-351. doi: 10.1053/j.jvca.2017.08.043. Epub 2017 Aug 30.

Authors

Benjamin Sohmer¹, Reza Jafar², Prakash Patel³, Marie-Ève Chamberland⁴, Michel R Labrosse⁵, Munir Boodhwani⁶

Affiliations

¹ Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. Electronic address: bsohmer@ottawaheart.ca.
² Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Mechanical Engineering, University of Ottawa, Ottawa, Ontario, Canada.
³ Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA.
⁴ Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
⁵ Department of Mechanical Engineering, University of Ottawa, Ottawa, Ontario, Canada.
⁶ Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.

PMID: 29128482
DOI: 10.1053/j.jvca.2017.08.043

Abstract

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 FE 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 FE simulations.

Measurements and main results: 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).

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.

Keywords: 3-dimensional transesophageal echocardiography; aortic insufficiency; aortic valve; cusp coaptation surface area; echocardiography; sinotubular junction; ventriculo-aortic junction.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aortic Valve / diagnostic imaging
Aortic Valve / surgery
Aortic Valve Insufficiency / diagnostic imaging*
Aortic Valve Insufficiency / surgery
Computer Simulation*
Echocardiography, Three-Dimensional / methods*
Echocardiography, Transesophageal / methods*
Female
Humans
Male
Monitoring, Intraoperative / methods*
Severity of Illness Index*