A correlative study of aortic valve rotation angle and thoracic aortic sizes using ECG gated CT angiography

Saremi, Farhood; Cen, Steven; Tayari, Nazila; Alizadeh, Hussain; Emami, Amir; Lin, Leah; Fleischman, Fernando

doi:10.1016/j.ejrad.2017.01.009

Cited by 19 publications

(20 citation statements)

References 21 publications

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“…In terms of rotation, the aortic root was neutral in position in two‐thirds of the patients, but was rotated in clockwise fashion in 18%, and rotated counterclockwise in 16%. In keeping with our previous findings (Saremi et al ), the mean angle of rotation was 10.1 ± 16.6°, with a range from −39.0° to 52.5°. The mean height of wedging was 39.0 ± 7.0 mm (Table ), again mirroring our previous findings (Mori et al ).…”

Section: Resultssupporting

confidence: 93%

“…Based on our previous experiences (Massing and James, ; Anderson et al ; Saremi and Krishnan, ; Mori et al , ; Tretter et al ), therefore, we have revisited the living anatomy of the membranous septum using computed tomographic angiography. Our study has revealed potentially important clinical correlations between its size and various measurements of the aortic root, including dilation, rotation, elongation, tilting, and wedging (Tretter et al ; Mori et al ; Saremi et al ).…”

Section: Introductionmentioning

confidence: 76%

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Relationship between the membranous septum and the virtual basal ring of the aortic root in candidates for transcatheter implantation of the aortic valve

et al. 2018

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Knowledge of the anatomy of the membranous septum, as a surrogate to the location of the atrioventricular conduction axis, is a prerequisite for those undertaking transcatheter implantation of the aortic valve (TAVI). Equally important is its relationship of the virtual basal ring. This feature, however, has yet to be adequately described in the living heart. We analyzed computed tomographic angiographic datasets from 107 candidates (84.1 ± 5.2 years, 68% women) for TAVI. Using multiplanar reconstructions, we measured the height and width of the membranous septum, and the distances of its superior and inferior margins from the virtual basal ring plane. We also assessed the extent of wedging of the aortic root between the mitral valve and the ventricular septum. Mean heights and widths of the membranous septum were 6.6 ± 2.0, and 10.2 ± 3.1 mm, respectively, with its size significantly associated with that of the aortic root (P < 0.05). Its superior and inferior margins were 4.5 ± 2.3 and 2.1 ± 2.1 mm, respectively, from the plane of the basal ring. The inferior distance, the surrogate for the adjacency of the atrioventricular conduction axis, was ≤ 5mm in 91% of the patients. Deeper wedging of the aortic root was independently correlated with a shorter inferior distance (β = 0.0569, P = 0.0258). The membranous septum is appreciably closer to the virtual basal ring than previously appreciated. These findings impact on estimations of the risk of damage to the atrioventricular conduction axis during TAVI. Clin. Anat. 31:525-534, 2018. © 2018 Wiley Periodicals, Inc.

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Section: Resultssupporting

confidence: 93%

Section: Introductionmentioning

confidence: 76%

Relationship between the membranous septum and the virtual basal ring of the aortic root in candidates for transcatheter implantation of the aortic valve

et al. 2018

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“…It is possible that the changes observed may reflect ageing, including dilation and elongation. CT investigations, which correlated clockwise rotation with dilation of the ascending aorta, however, revealed no association with age 10. Our current findings, therefore, endorse the notion of a congenital aetiology for the rotation, although we found no association between the rotation of the root and the dimensions of the membranous septum.…”

Section: Discussionsupporting

confidence: 51%

“…The membranous septum is also known to vary in size,7 8 variation recognisable using CT analysis 9. This analysis has also served to identify variation in the rotation of the aortic root relative to the underlying ventricular mass 10. A systematic investigation of variability in the anatomy of the membranous septum relative to rotation of the aortic root, however, has yet to be conducted.…”

Section: Introductionmentioning

confidence: 99%

Variations in rotation of the aortic root and membranous septum with implications for transcatheter valve implantation

Tretter

Mori

Saremi

et al. 2017

Heart

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“…Variation in the rotational position of the aortic root has received attention only in the settings of congenital cardiac malformations, such as tetralogy of Fallot, in which there is often clockwise rotation of the root when viewed inferiorly from the left ventricle (Isaaz et al, ). Recent investigations have revealed that there is also variation in the rotation of the aortic root relative to the base of the left ventricle in normal hearts (Saremi et al, ; Tretter et al, ). When rotated in clockwise fashion, this is associated with widening of the central fibrous body.…”

Section: Introductionmentioning

confidence: 99%

The rotational position of the aortic root related to its underlying ventricular support

et al. 2019

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We aimed to assess the relationship of the rotational position of the aortic root to its underlying ventricular support, and to the position of the inferior margin of the membranous septum, which serves as a surrogate of the atrioventricular conduction axis. We analyzed 40 normal heart specimens (19 children, 21 adults). The inferior margin of the membranous septum was measured relative to the virtual basal ring. The rotational position of the aortic root was determined by assessing the relationship of the aortic leaflet of the mitral valve to the interleaflet triangle between the non-and left coronary leaflets. The extent of supporting fibrous versus myocardial tissues was measured. We also performed a similar investigation of 30 adult computed tomographic data sets. The median age was 0.25 years (44% male) for children, and 64 years (33% male) for adults. The aortic root was positioned centrally in 22 specimens (55%), rotated counterclockwise in 6 (15%), and clockwise in 12 (30%). In the setting of counterclockwise rotation, 53.4% (median) of the supporting circumference was myocardial, as opposed to 41.4% (median) in those with centrally positioned roots, and 31.9% (median) in those with clockwise rotation (P < 0.0001). The position of the inferior margin of the membranous septum was not associated with the rotational position. Analysis of the 30 adult computed tomographic data sets (median age 66.5 years, 57% male) confirmed the positive relationship between clockwise rotation of the aortic root and an increase in the extent of fibrous as opposed to myocardial support. The rotational position of the aortic root correlates with variation in the extent of its fibrous as opposed to myocardial ventricular support, but not with the position of the inferior margin of the membranous septum relative to the virtual basal ring.

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A correlative study of aortic valve rotation angle and thoracic aortic sizes using ECG gated CT angiography

Cited by 19 publications

References 21 publications

Relationship between the membranous septum and the virtual basal ring of the aortic root in candidates for transcatheter implantation of the aortic valve

Relationship between the membranous septum and the virtual basal ring of the aortic root in candidates for transcatheter implantation of the aortic valve

Variations in rotation of the aortic root and membranous septum with implications for transcatheter valve implantation

The rotational position of the aortic root related to its underlying ventricular support

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