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Asymmetrical Aortic Valve Leaflets
Antonio F. Corno, Taylor S. Koerner, Mayme E. Marshall, Lauren S. Talley, Megan E. Childress, Thomas Cunningham, Rami M. Kharouf, Wen Li, Jorge D. Salazar.
UTHealth of Houston Science Center, Houston, TX, USA.

Objective(s):
To evaluate the relative size of aortic valve leaflets in children with congenital heart defects, and the potential correspondence with coronary artery anatomy.
Methods:
One-hundred fifty-eight children with congenital heart defects (mean age 229315days, mean weight 7.35.8kg), underwent pre-operative transthoracic echocardiography (TTE) and intra-operative transesophageal echocardiography (TEE). Exclusion criteria were the presence of bicuspid aortic valve and hypoplastic aortic valve annulus. Measurement of length and inter-commissural distance of each leaflet were performed on TTE and TEE by two independent observers, and area was calculated using a geometrical formula. Nonparametric, Wilcoxon and Friedman tests were used for statistical analysis. Results:On TTE and TEE, non-coronary leaflet had length, inter-commissural distance and area significantly larger than other two leaflets (P<0.001); left coronary leaflet was significantly longer than right (P<0.001), with shorter inter-commissural distance (P<0.001), without statistical difference between their areas.In 15/158 (=9.5%) patients with anomalous coronary arteries and major blood supply from right sinus, there was a trend with right coronary leaflet having smaller area than the left: 16.7 vs 17.8mm2 on TTE, and 24.0 vs 25.2mm2 on TEE, without reaching statistically significant difference because of the small sample size. Conclusions:The aortic valve leaflets are asymmetrical, with non-coronary leaflet significantly larger than right and left. The shape of right leaflet is different from the shape of the left.In the presence of anomalous origin of the coronary arteries, the major source of coronary blood flow from right sinus seems associated with a reversal of right and left leaflets morphology.


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