Geometric and morphological assessment of structurally normal tricuspid aortic valves based on body surface area using 3D transesophageal echocardiography

Background Aortic valve geometry is a key parameter for aortic valve repair, which serves as a surgical alternative to valve replacement for aortic insufficiency treatment. Individuals with different body sizes may exhibit varying geometric parameters of the aortic valve. This study aims to provide a detailed assessment of normal aortic valve geometric indices and their relationship to body surface area (BSA) using three-dimensional transesophageal echocardiography (3D TEE), addressing limitations of standard transthoracic echocardiography data and aiding in predicting the feasibility of valve repair and guiding appropriate patient selection. Methods In this cross-sectional analytical study, sixty-three patients with structurally normal tricuspid aortic valves undergoing TEE for non-aortic-valve indications were enrolled. Comprehensive 3D TEE of aortic valve was performed and evaluated. Results The mean BSA was 1.85 ± 0.20 m². The mean maximal aortic annular diameter was 22.30 ± 3.36 mm, and the mean annular perimeter was 69.59 ± 8.31 mm. The left coronary cusp had the greatest GH (16.5 mm), while the right coronary cusp had the greatest EH (8.47 mm). In crude comparisons, males had greater RCC GH than females (difference, 2.9 mm; 95% CI, 1.7–4.0; p < 0.001), greater LCC GH (difference, 2.0 mm; 95% CI, 0.92–3.1; p < 0.001), and greater RCC EH (difference, 1.3 mm; 95% CI, 0.51–2.2; p = 0.002). After BSA indexing, these differences were no longer statistically significant for RCC GH (p = 0.129), LCC GH (p = 0.917), or RCC EH (p = 0.332). However, BSA-indexed LVOT area and aortic annular area remained significantly greater in males (p = 0.005 and p = 0.016, respectively). Inter-observer ICCs ranged from 0.84 to 0.92, and intra-observer ICCs from 0.89 to 0.95. Conclusion Significant sex-based differences in aortic valve geometries are attenuated after BSA adjustment. Moreover, comparison with previous studies suggests that variations in aortic valve parameters across populations are likely attributable to differences in BSA. The measurements presented in this study should be considered exploratory 3D TEE-derived reference data rather than definitive normative values and require validation in larger, multicenter cohorts.