Aortic valve leaflet and root dimensions in normal tricuspid aortic valves: a computed tomography study

Background and aim of the study Objective of this analysis was to use coronary computed tomography in patients with normal tricuspid aortic valves to perform detailed aortic root and aortic valve geometric analysis with focus on asymmetry of the three leaflets. Materials and methods We analyzed aortic valves in 70 anonymized coronary computed tomography angiograms. Mean patient age was 53 ± 11 years. All aortic valves were tricuspid, without calcifications and aortic roots were of normal dimensions. Asymmetry of the three leaflets in individual patients was assessed by calculating absolute and relative differences between the largest and the smallest of the three leaflets. Results Some degree of asymmetry was present in all analyzed valves. Absolute and relative differences for free margin length were 3.2 ± 1.4 mm and 9.3 ± 3.8%, respectively. The largest relative difference was noted in coaptation area (36.5 ± 16.5%) and the smallest in leaflet effective height (6.1 ± 4.8%). Using predefined cut-off criteria for absolute differences in leaflet dimensions, 86% of the valves were classified as asymmetric. Conclusions Equal free margin length of the three leaflets is not needed for normal tricuspid aortic valve function. Aligning the leaflet free margin length in standardized aortic valve repair may not be necessary in tricuspid aortic valve repair, whereas equalization of effective leaflet heights is.