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Determinants of the Degree of Functional Aortic Regurgitation in Patients With Anatomically Normal Aortic Valve and Ascending Thoracic Aorta Aneurysm Transesophageal Doppler Echocardiography Study
  1. Giovanni La Canna (lacanna.giovanni{at}
  1. San Raffaele Hospital, Italy
    1. Francesco Maisano (francesco.maisano{at}
    1. San Raffaele Hospital, Italy
      1. Lucrezia De Michele (demichele.lucrezia{at}
      1. San Raffaele Hospital, Italy
        1. Antonio Grimaldi (grimaldi.antonio{at}
        1. San Raffaele Hospital, Italy
          1. Francesca Grassi (grassi.francesca{at}
          1. San Raffaele Hospital, Italy
            1. Elvia Capritti (capritti.elvia{at}
            1. San Raffaele Hospital, Italy
              1. Michele De Bonis (debonis.michele{at}
              1. San Raffaele Hospital, Italy
                1. Ottavio Alfieri (alfieri.ottavio{at}
                1. San Raffaele Hospital, Italy


                  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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