Heart 2009;95:130-136
ORIGINAL ARTICLES
Valvular heart disease
Determinants of the degree of functional aortic regurgitation in patients with anatomically normal aortic valve and ascending thoracic aorta aneurysm. Transoesophageal Doppler echocardiography study
1 Echocardiography Unit, San Raffaele Hospital, Milan, Italy
2 Cardiac Surgery Department, San Raffaele Hospital, Milan, Italy
Dr G La Canna, H San Raffaele, Via Olgettina 60, 20132 Milan, Italy; lacanna.giovanni{at}hsr.it
Objectives: To identify functional aortic regurgitation (FAR) determinants in patients with ascending thoracic aortic aneurysm (ATAA) and surgically confirmed normal aortic valve anatomy.
Design: Case–control study.
Setting: Non-invasive Cardiology and Cardiac Surgery Department.
Patients: Eighty-nine patients with ATAA and varying degrees of FAR undergoing surgery, 40 age-matched patients with ATAA without aortic regurgitation and 20 normal control subjects.
Interventions: Doppler and two-dimensional transoesophageal echocardiography.
Main outcome measures: Vena contracta (VC) of aortic regurgitant jet, diastolic tented area and coaptation height (CH) of aortic valve leaflets, aortic dimension indexes—Valsalva sinus, sinotubular junction (STJ), tubular tract, annulus (A), STJ/A ratio.
Results: When VC was used, a wide range of FAR was seen (mean (SD) 5.59 (2.59) mm, ranging from 2 to 13 mm). Of the variables tested, the most strongly associated with FAR severity in multivariate analysis was diastolic leaflet tenting, measured as CH (R2 = 0.69) (sensitivity 98%, specificity 95% using a cut-off value of CH 
1.1 cm). In turn, the diastolic leaflet tenting was strongly identified by the STJ/A ratio (sensitivity 87%, specificity 71% using a cut-off value of STJ/A >1.66).
Conclusion: The diastolic tenting of aortic leaflets is strongly related to FAR severity in patients with ATAA. The mismatch of STJ/A is significantly associated with diastolic leaflet tenting and its correlated valve regurgitation, independently of the actual ATAA dimension. These findings provide new insight into the mechanism of FAR arising from ATAA.
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