Therefore, tracing more outer dense line rather than tracing inner border of the aortic wall may be a better method. Last but not least, how can we apply the findings revealed in this study using RT3DE images about aortic

root volume and geometry into clinical practice? Since the study excluded patients who have any pathologic findings that could affect aortic root geometry, the results of this study cannot be extrapolated to the patients suffering from aortic root pathology. Further investigations should be necessary to verify whether this study result remains true in patients with aortic Inhibitors,research,lifescience,medical root pathology such as aortic annuloectasia and Marfan syndrome. RT3DE evaluation of aortic root volume may be useful in following up aortic root dilation in such patients

as well as patients with aortic regurgitation.9) The find more analyses using RT3DE of geometric components constituting entire aortic root may be of greater clinical use than Inhibitors,research,lifescience,medical simple measurement of aortic root volume. Although aortic annulus may not be a distinct anatomic structure,10) evaluating annulus shape and diameters Inhibitors,research,lifescience,medical is essential to implement transcatheter aortic valve implantation. In the current study, aortic annulus appeared to be asymmetric triangular. Aortic annulus shape was reported to be oval rather than circular in previous reports.11),12) Annulus shape and diameter can be evaluated in each patient and taken into consideration in determining prosthetic valve size.13) The distance between aortic Inhibitors,research,lifescience,medical annulus and ostium of coronary arteries, which is critical in performing transcatheter aortic valve implantation, can be measured from CT images.12),14) Inhibitors,research,lifescience,medical This parameter may be also measurable from the images of transesophageal RT3DE. Furthermore, aortic root dilation is not always uniform and symmetrical, but rather eccentric and asymmetrical. One coronary sinus may be substantially more enlarged than other two sinuses.15),16)

The asymmetry of sinus dilation and individual variation may be visualized and quantified using RT3DE, and this geometric information may be useful to surgeon about in planning aortic valve repair surgery or aortic root replacement with the use of stentless auto-, homo- and xenografts. The measurement of individual volumes of each sinus may provide more clinically relevant information.16) Finally, 3-dimensional deformations of aortic root during a cardiac cycle have been evaluated in several animal studies.17-19) Geometric analysis for 3-dimensional deformation of human aortic root may be possible using RT3DE, and it may provide physiologic information regarding aortic accommodation of ejected stroke volume and help to develop more ideal method for aortic root surgery.