Morphological analysis of aortic root in eccentric aortic regurgitation using anyplane two-dimensional images produced by transesophageal three-dimensional echocardiography

Background and aim of the study: Evaluation of leaflet dysfunction in aortic valve repair is important. In eccentric aortic regurgitation (AR), it is unclear whether leaflet dysfunction other than prolapse exists. The study aim was to validate the hypothesis that eccentric AR correlates with leaflet dysfunction. Methods: Both anyplane 2-D images produced by a 3D reconstruction system and surgical views for 21 patients with eccentric AR (11 with aortic valve prolapse, group A, 10 without prolapse, group B) were analyzed prospectively. Vertical height from annulus to coaptation point (termed AC), and distance from coaptation point to sinotubular junction (CS) were measured at early diastole. Results: For group A, AC and CS values were 1.3 +/- 2.2 mm and 25.9 +/- 3.4 mm respectively for leaflets of eccentric AR jet origin, and 3.8 +/- 0.4 mm. and 22.7 2.1 mm. for other leaflets. For group B, AC and CS values were 4.7 +/- 0.9 mm and 39.8 +/- 7.0 mm for leaflets of eccentric AR jet origin, and 7.8 +/- 0.9 mm. and 31.9 5.7 mm for other leaflets. The AC for leaflets of eccentric AR jet origin was smaller than AC for other leaflets (p < 0.01) between both groups. There was no difference between CS for leaflets of eccentric AR jet origin and other leaflets in group A, but CS for leaflets of eccentric AR jet origin was larger than for other leaflets in group B (p < 0.01). AC and CS values for leaflets of eccentric AR jet origin in group B were larger than those for group A. Leaflets of eccentric AR jet origin were always shifted toward the direction of the base in the anyplane images, and elongated in the surgical view. Conclusion: Anyplane 2-D images obtained by 3-D echocardiography showed that aortic leaflets of eccentric AR jet origin shifted towards the direction of the base with or without prolapse, and were accompanied by dysfunction. Color flow Doppler determination of the eccentricity of AR jet origin was useful in predicting aortic valve dysfunction.