Perioperative dynamic morphological changes of the aortic annulus during aortic root remodeling with aortic annuloplasty at systolic and diastolic phases.

Objective: The study aim was to determine the three-dimensional motion of the semilunar attachment of leaflets (annulus) and the aortic root in annuloaortic ectasia with aortic insufficiency (AI).

Methods: Five patients (four males, one female) underwent preoperative and postoperative 64-row, multidetector computed tomography (MDCT) and aortic root remodeling with aortic annuloplasty. The control group comprised 25 subjects who underwent MDCT scanning for reasons other than cardiac evaluation. The aortic annulus was measured at systole and diastole, and then divided into the right coronary cusp (RCC), left coronary cusp (LCC) and non-coronary cusp (NCC). The lengths of the aortic annulus, sinus of Valsalva and sinotubular junction (STJ) were also measured at systole and diastole on longitudinal views.

Results: The preoperative and postoperative systolic and diastolic lengths of the RCC, LCC and NCC did not differ significantly, but all were significantly larger than those in control subjects. The preoperative diameters of the aortic annulus and STJ were significantly larger at systole than at diastole. However, the control findings indicated that only the STJ diameter was larger at systole than at diastole.

Conclusions: The aortic annulus length did not change perioperatively at systole and diastole. Aortic root remodeling with aortic annuloplasty corrects the preoperative motion of the aortic annulus and STJ, which might be the cause of AI, although STJ distensibility was restricted.