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J Thorac Cardiovasc Surg 2009;137:950-956
© 2009 The American Association for Thoracic Surgery

Evolving Technology

Aortic root morphology in patients undergoing percutaneous aortic valve replacement: Evidence of aortic root remodeling

^a Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
^b Division of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
^c Department of Vascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
^d Division of Radiology, Cleveland Clinic Foundation, Cleveland, Ohio

Received for publication May 25, 2008; revisions received July 16, 2008; accepted for publication July 31, 2008.

^_* Address for reprints: Srikanth Sola, MD, FACC, FAHA, Department of Cardiovascular Medicine, The Cleveland Clinic, 9500 Euclid Avenue, Desk F-15, Cleveland, OH 44195. (Email: solas{at}ccf.org).

Objective: Percutaneous aortic valve replacement is an emerging therapy for selected patients with severe aortic stenosis. Preoperative imaging of the aortic root facilitates sizing and deployment of the percutaneous aortic valve replacement device. We compared morphologic characteristics of the aortic root in patients with aortic stenosis versus elderly gender-matched controls using multidetector computed tomography.

Methods: Twenty-five consecutive subjects with severe calcific aortic stenosis referred for percutaneous aortic valve replacement and 25 elderly gender-matched controls were scanned on a Siemens Definition Dual Source (Siemens Medical, Forchheim, Germany) multidetector computed tomography scanner. Distances from the valve annulus to the coronary artery ostia and sinotubular junction, dimensions of the aortic root, and characteristics of the valve cusps were determined.

Results: Subjects with aortic stenosis had reduced distance from the aortic valve annulus to the inferior margins of the left and right coronary artery ostium and sinotubular junction compared with controls. There were no significant differences in cross-sectional dimensions of the aortic root.

Conclusion: The distance from the aortic valve annulus to the coronary artery ostia and sinotubular junction is reduced in patients with aortic stenosis compared with controls. This finding suggests that longitudinal remodeling of the aortic root occurs in calcific aortic stenosis and has implications for the design and deployment of percutaneous aortic valve replacement devices.

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