Aortic root morphology in patients undergoing percutaneous aortic valve replacement: Evidence of aortic root remodeling Mateen Akhtar, MD, E. Murat Tuzcu,

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Aortic root morphology in patients undergoing percutaneous aortic valve replacement: Evidence of aortic root remodeling Mateen Akhtar, MD, E. Murat Tuzcu, MD, Samir R. Kapadia, MD, Lars G. Svensson, MD, PhD, Roy K. Greenberg, MD, Eric E. Roselli, MD, Sandra Halliburton, PhD, Vikram Kurra, MBBS, Paul Schoenhagen, MD, Srikanth Sola, MD The Journal of Thoracic and Cardiovascular Surgery Volume 137, Issue 4, Pages 950-956 (April 2009) DOI: 10.1016/j.jtcvs.2008.07.062 Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Long-axis (A) and corresponding short-axis views of the aortic valve annulus (B), sinuses of Valsalva (C), and sinotubular junction (D). Measurements of the sinuses of Valsalva were made from the commissures between 2 cusps to the middle of the opposite cusp (C). Measurements at the other levels of the aortic root were made using the largest cross-sectional diameter from the short-axis image. ST, Sinotubular; SOV, sinuses of Valsalva; AN, annulus. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 950-956DOI: (10.1016/j.jtcvs.2008.07.062) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Imaging plane used to measure the distance from the aortic valve to the inferior margin of the coronary ostia. Measurements were made from the oblique coronal view during systole. The left coronary artery is shown in this image. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 950-956DOI: (10.1016/j.jtcvs.2008.07.062) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Imaging plane used to define the leaflet height and effective cusp height. A, Leaflet height, defined as the longest length of the cusp from the annulus to the cusp tip, was measured in diastole from the long-axis view going through the center of each cusp. Effective cusp height, defined as the vertical distance between the cusp from the annulus to the cusp tip, was measured in diastole from the same plane as the cusp height. B, Schematic diagram illustrating leaflet height and effective cusp height. STJ, Sinotubular junction; LH, leaflet height; ECH, effective cusp height. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 950-956DOI: (10.1016/j.jtcvs.2008.07.062) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 The free margin length of each cusp was measured during diastole from the short-axis view. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 950-956DOI: (10.1016/j.jtcvs.2008.07.062) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Changes in aortic root morphology in AS. A, Normal aortic root (green). B, Aortic root in AS (blue). Compared with controls, distances from aortic valve annulus to sinotubular junction (1) and aortic valve annulus to left or right coronary artery ostia (2) are reduced. The effective cusp height (3) is increased in AS group compared with controls. C, Overlapping aortic root for AS and control groups. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 950-956DOI: (10.1016/j.jtcvs.2008.07.062) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions