The myth of aortic valve annulus changes in aortic valve disease

Figures

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  Figure 1. Cross tabulation of valve selection between systolic and diastolic measurements for perimeter. (A) Cross tabulation of valve selection in patient with systolic enlargement group. Values highlighted in dark green boxes indicate concordance between valve selection in diastolic and systolic measurements. Values highlighted in light red show the number of cases where systolic measurements would result in a larger valve size recommendation. (B) Cross tabulation of valve selection in patient with systolic enlargement group. Values highlighted in dark green boxes indicate concordance between valve selection in diastolic and systolic measurements. Values highlighted in light red show the number of cases where diastolic measurements would result in a larger valve size recommendation.

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  Figure 2. ROC curves for factors influencing annular dimensions in systolic and diastolic phases. (A) The figure displays the ROC curves for various predictors in determining whether the aortic annulus is larger during systole or diastole. The solid blue line illustrates the combined predictive power of sex and the systolic AnMin index. The dashed orange line represents the Systolic AnMin index, the solid purple line for Systolic AnEI, the dotted red line for Sex, and the dashed green line for Systolic AnMin. (B) The figure compares the ROC curves for the AS and AR subgroups based on the combined sex and Systolic AnMin index. The solid blue line represents the AS subgroup, and the solid orange line corresponds to the AR subgroup. AUC, areas under the curve; ROC, receiver operating characteristic.

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  Figure 3. Annular changes in a patient with aortic regurgitation. The annulus was elliptical during systole and assumed a cloverleaf pattern during diastole, resulting in a significant reduction in the annular perimeter and area.

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  Figure 4. Systolic and diastolic conformation of the annulus. The left column of (A–C) represents the systolic phase, while the right column represents the diastolic phase. The top row shows schematic diagrams, the middle row presents the annular plane views, and the bottom row depicts longitudinal sectional views of the AnMin. In (A), during systole, the fibromuscular junction protrudes toward the left atrium, leading to a smaller AnMin, causing the annulus to appear larger in systole. In (B), during systole, the thickened interventricular septum contracts, leading to compression of the annulus, which reduces the perimeter and area of the annulus, making it larger in diastole. In (C), during diastole, the AnMax increases, which increases the perimeter and area of the annulus, making it larger in diastole. A, aortic valve; AnMax, annulus maximum; AnMin, annulus minimum;LV, left ventricle; M, mitral valve; m, muscle; RV, right ventricle.