• Arash Khamooshian, Yannis Amador, Ting Hai, Jelliffe Jeganathan, Maria Saraf, Eitezaz Mahmood, Robina Matyal, Kamal R Khabbaz, Massimo Mariani, and Feroze Mahmood.
• Department of Cardio-Thoracic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
• J. Cardiothorac. Vasc. Anesth. 2017 Aug 1; 31 (4): 1290-1300.

ObjectiveTo provide (1) an overview of the aortic valve (AV) apparatus anatomy and nomenclature, and (2) data regarding the normal AV apparatus geometry and dynamism during the cardiac cycle obtained from three-dimensional transesophageal echocardiography (3D TEE).DesignRetrospective feasibility study.SettingA single-center university teaching hospital.ParticipantsThe study was performed on data of 10 patients with a nonregurgitant, nonstenotic aortic valve undergoing cardiac surgery.InterventionsIntraoperative 3D TEE was performed on all the participants using the Siemens ACUSON SC2000 ultrasound system and Z6Ms transducer (Siemens Medical Systems, Mountainview, CA).Measurements And Main ResultsDynamic offline analyses were performed with Siemens eSie valve analytical software in a semiautomated fashion. Forty-five parameters were exported of which 13 were selected and analyzed. The cardiac cycle was divided into 4 quartiles to account for frame-rate variations. The annulus, sinus of Valsalva (SoV) and sinotubular junction (STJ) areas, diameter, perimeter and height, aortic leaflet height, leaflet coaptation height, and aortic valve-mitral valve angle changed significantly during the cardiac cycle (p < 0.001). STJ expanded more than both the annulus and the SoV (p < 0.001). The maximum aortic valve leaflet height change was greater in the left and right versus noncoronary leaflet (p < 0.001).ConclusionsThe semiautomated AV apparatus dynamic assessment using eSie valve software is a clinically feasible technique and can be performed readily in the operating room. It has the potential to significantly impact intraoperative decision-making in cases suitable for AV repair. The AV apparatus is a dynamic structure and demonstrates significant changes during the cardiac cycle.Copyright © 2017. Published by Elsevier Inc.

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