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 FAR degree undergoing surgery and 40 age-matched ATAA without aortic regurgitation and 20 normal control subjects.
Interventions Doppler and two-dimensional transesophageal echocardiography
Main outcome measures Vena contracta (VC) of aortic regurgitant jet, diastolic tented area (TA) and coaptation height (CH) of aortic valve leaflets, aortic dimension indexes -Valsalva sinus (VS), sino-tubular junction (STJ), tubular tract (TT), anulus (A), STJ/A ratio.
Results Using VC, a wide range of FAR was observed (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 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 to diastolic leaflet tenting and its correlated valve regurgitation, independent of the actual ATAA dimension. These findings provide new insight into FAR mechanism arising from ATAA.
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