There is continued interest in surgical repair of both the congenitally malformed aortic valve, and the valve with acquired dysfunction. Aortic valvar repair based on a geometric approach has demonstrated improved durability and outcomes. Such an approach requires a thorough comprehension of the complex 3-dimensional anatomy of both the normal and congenitally malformed aortic root. In this review, we provide an understanding of this anatomy based on the features that can accurately be revealed by contrast-enhanced computed tomographic imaging. We highlight the complimentary role that such imaging, with multiplanar reformatting and 3-dimensional reconstructions, can play in selection of patients, and subsequent presurgical planning for valvar repair. The technique compliments other established techniques for perioperative imaging, with echocardiography maintaining its central role in assessment, and enhances direct surgical evaluation. This additive morphological and functional information holds the potential for improving selection of patients, surgical planning, subsequent surgical repair, and hopefully the subsequent outcomes.

Aims Mitral annular disjunction is fibrous separation between the attachment of the posterior mitral leaflet and the basal left ventricular myocardium initially described in dissected hearts. Currently, it is commonly evaluated by echocardiography, and potential relationships with mitral valve prolapse and ventricular arrhythmia have been suggested. However, controversy remains as its prevalence and extent have not been fully elucidated in normal living subjects. Methods and results Systolic datasets of cardiac computed tomography obtained from 98 patients (mean age, 69.1 ± 12.6 years; 81% men) with structurally normal hearts were assessed retrospectively. Circumferential extent of both mitral leaflets and disjunction was determined by rotating orthogonal multiplanar reconstruction images around the central axis of the mitral valvar orifice. Distribution angle within the circumference of the mitral valvar attachment and maximal height of disjunction were quantified. In total, 96.0% of patients demonstrated disjunction. Average distribution angles of the anterior and posterior mitral leaflets were 91.3 ± 9.4° and 269.8 ± 9.7°, respectively. Average distribution angle of the disjunction was 105.1 ± 49.2°, corresponding to 39.0 ± 18.2% of the entire posterior mitral valvar attachment. Median value of the maximal height of disjunction was 3.0 (1.5–7.0) mm. Distribution prevalence map of the disjunction revealed characteristic double peaks, with frequent sites of the disjunction located at the anterior to antero-lateral and inferior to infero-septal regions. Conclusion Mitral annular disjunction is a rather common finding in the normal adult heart with bimodal distribution predominantly observed involving the P1 and P3 scallops of the posterior mitral leaflet.

few quantitative data on the repair-oriented 3-dimensional anatomy of the aortic root are currently available, which impairs standardization of the surgical technique. 1,11 The aim of the present study is to measure the precise metrics of the normal aortic valve as the standard value for guiding successful surgical repair by using computed tomography. 15 Methods Study PopulationWe retrospectively analyzed the datasets obtained from 264 consecutive patients who underwent cardiac computed A ortic valve-sparing surgery has become one of the popular operational options for the primarily regurgitant valve and/or proximal aortic aneurysm over the last few decades. 1-5 Although outcomes of aortic valve-sparing surgery have improved, 6-8 there remain problems, including intraoperative conversion to aortic valve replacement or recurrence of aortic regurgitation. 9-11 As the aortic root anatomy is too complicated to accurately evaluate only with 2-dimensional methodology, 2,12,13 3-dimensional evaluation is necessary to reveal the underlying mechanism of the aortic regurgitation and to define the predictors of successful surgical repair. 11,12,14 However,

Late restenosis occurs after PCB angioplasty for DES-ISR lesions.

There are significant differences in the diameters of the aortic root, which represent the echocardiographic annulus, when measured using bisecting as opposed to off-center cuts. Account should be taken of these differences when using cross-sectional echocardiographic measurements to assess the dimensions of the aortic root.

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Background: Because the aortic root anatomy is too complicated to evaluate only with 2D methodology, precise appreciation of its 3D anatomy is a prerequisite for all cardiologists and cardiac surgeons. Methods and Results:We provide comprehensive image panels reconstructed from CT datasets to understand the complexity of the aortic root by focusing on the representative longitudinal sections cut through the central zone of coaptation. Conclusions:The provided images will accelerate profound understanding of the 2D long-axis image of the aortic root commonly interrogated with 2D echocardiography, as well as correlated clinical measured values, including the geometric height, effective height, and coaptation length.

: Traditionally, gross cardiac anatomy has been described mainly based on the findings in the dissection suite. Analyses of heart specimens have contributed immensely towards building a fundamental knowledge of cardiac anatomy. However, there are limitations in analyzing the autopsied heart removed from the thorax. Three-dimensional imaging allows visualization of the blood-filled heart in vivo in attitudinally appropriate fashion. This is of paramount importance for not only demonstration of cardiac anatomy for educational purposes, but also for the detailed anatomical evaluation in patients with acquired and congenital heart disease. In this review, we discuss the advantages of three-dimensional imaging, specifically focusing on virtual dissection, a volume rendering-based reconstruction technique using computed tomographic data. We highlight examples of three-dimensional imaging in both education and guiding patient management.