Determinants of effective height in morphologically normal tricuspid aortic valves: A computed tomography-based anatomical study

Objectives To analyse the relationship between effective height and other morphological parameters of the aortic valve complex when the aortic valve is closed. Methods We retrospectively analysed 105 patients (mean age 70.7±10.1 years) with morphologically normal aortic valves, roots, or ascending aortas who had undergone electrocardiography-gated cardiac computed tomography as a screening test of the coronary artery, from August 2014 to December 2018. Parameters of the aortic valve complex configuration (effective height, geometric height, aortic annular diameter, sinus of Valsalva diameter, sinotubular junction diameter, commissure height, and Valsalva height) in diastole were measured using Ziostation2 software. Pearson’s correlation was used to evaluate the associations between the effective height and other parameters. Multiple regression analysis was performed to evaluate the variables independently associated with effective height. Results Significant associations were observed between the effective height and geometric height, sinus of Valsalva diameter, sinotubular junction diameter, commissure height, and Valsalva height (all p < 0.001) but not between effective height and aortic annular diameter (p = 0.227). Multivariable analysis showed that geometric height, aortic annular diameter, and sinotubular junction diameter were independently associated with effective height (all p < 0.001; overall model fit: R2=0.739). Conclusions Our findings demonstrate that effective height is strongly associated with geometric height, which remained independently associated after adjustment, along with aortic annular and sinotubular junction diameters. These results provide quantitative in vivo evidence regarding the anatomical determinants of effective height in morphologically normal tricuspid aortic valves and may serve as anatomical reference data for future research on individualised approaches to aortic valve repair.