Handa Kazuma, Kawamura Masashi, Yoshioka Daisuke, Saito Shunsuke, Kawamura Takuji, Kawamura Ai, Misumi Yusuke, Komukai Sho, Kitamura Tetsuhisa, Miyagawa Shigeru
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Division of Biomedical Statistics, Department of Integrated Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
Interdiscip Cardiovasc Thorac Surg. 2025 Mar 5;40(3). doi: 10.1093/icvts/ivaf046.
This study aimed to classify anatomical variations in aortic root rotation using preoperative three-dimensional transoesophageal echocardiography (3D-TEE), validate these findings with cardiac computed tomography (CT) in patients undergoing mitral valve surgery and evaluate the clinical impact on postoperative atrioventricular conduction disorders.
A total of 126 patients with normal electrocardiograms who underwent isolated mitral valve surgery were included. Anatomical variation was diagnosed using 3D-TEE, and aortic root rotation angle was measured using cardiac CT. New-onset postoperative atrioventricular block (AVB) and bundle branch block were analysed.
Variations of aortic root rotation were classified by 3D-TEE into two categories: 'center rotation' (normal) (85.7%, n = 108/126), where the commissure of the left and non-coronary aortic leaflet was located at center of the anterior mitral leaflet, and 'lateral rotation' (14.3%, n = 18/126), rotated to the lateral trigone side. The aortic root rotation angle, where the interatrial septum was defined as a reference, measured by cardiac CT strongly correlated with 3D-TEE findings ('center rotation' vs 'lateral rotation': 51.6° vs 64.6°, P < 0.001). The incidence of new-onset conduction disorder, all presenting with first-degree AVB, was significantly higher in the 'lateral rotation' than in the 'center rotation' (38.9% [n = 7/18] vs 5.6% [n = 6/108], P < 0.001). Aortic root rotation angles were identified as significant risk factors for postoperative first-degree AVB (odds ratio, 1.05; 95% confidential interval, 1.01-1.09; P = 0.027), with cutoff values of 58.7° predicting persistent new-onset AVB.
Aortic root rotation angle measured by cardiac CT validated 3D-TEE diagnosis of 'lateral rotation' of the aortic root. 'Lateral rotation' and larger aortic root rotation angles were significant risk factors for postoperative first-degree AVB following mitral valve surgery.
本研究旨在利用术前三维经食管超声心动图（3D-TEE）对主动脉根部旋转的解剖变异进行分类，在接受二尖瓣手术的患者中用心脏计算机断层扫描（CT）验证这些发现，并评估其对术后房室传导障碍的临床影响。
共纳入126例心电图正常且接受单纯二尖瓣手术的患者。使用3D-TEE诊断解剖变异，使用心脏CT测量主动脉根部旋转角度。分析术后新发房室传导阻滞（AVB）和束支传导阻滞情况。
3D-TEE将主动脉根部旋转变异分为两类：“中心旋转”（正常）（85.7%，n = 108/126），即左主动脉瓣叶与无冠状动脉瓣叶的交界位于前二尖瓣叶的中心；“外侧旋转”（14.3%，n = 18/126），旋转至外侧三角区一侧。以房间隔为参照，通过心脏CT测量的主动脉根部旋转角度与3D-TEE结果高度相关（“中心旋转”与“外侧旋转”：51.6°对64.6°，P < 0.001）。新发传导障碍的发生率在“外侧旋转”组显著高于“中心旋转”组，均表现为一度AVB（38.9% [n = 7/18]对5.6% [n = 6/108]，P < 0.001）。主动脉根部旋转角度被确定为术后一度AVB的显著危险因素（比值比，1.05；95%置信区间，1.01 - 1.09；P = 0.027），截断值为58.7°可预测持续性新发AVB。
心脏CT测量的主动脉根部旋转角度验证了3D-TEE对主动脉根部“外侧旋转”的诊断。“外侧旋转”和更大的主动脉根部旋转角度是二尖瓣手术后术后一度AVB的显著危险因素。
