Aortic Obstruction: Anatomy and Echocardiography

In This Article

Abstract and Background

Echocardiography is a valuable non-invasive technique for identifying the site and type of aortic obstruction. Knowledge of the morphological details of each type of obstruction is the basis for correct interpretation of the diagnostic images and clinical decisions. This study was undertaken to correlate the echocardiographic images with anatomic specimens of equivalent valvular and supravalvular aortic obstruction. Specimens were part of the collection of the Department of Embryology. Fifty six patients were studied, and forty specimens with aortic obstruction were analyzed.
Echocardiographic Characteristics: Thirty one (55.3%) patients were women and twenty five (44.7%) men. Valvular aortic obstruction was found in Thirty six patients (64.3 %) and supravalvular aortic obstruction in twenty (35.7%).
Anatomic characteristics: Of the forty specimens examined, twenty one (52.5%) had valvular aortic obstruction and nineteen (47.5%) supravalvular aortic obstruction.
The anatomoechocardiographic correlation clearly showed that the anatomic findings of the specimen hearts and aortas corresponded to echocardiographic images of valvular and supravalvular aortic obstruction and provided solid corroboration of echocardiographic diagnoses.

Obstructions of the aortic valve are determined by the dimensions of the fibrous ring, the number and morphological alterations of the semilunar leaflets that may be bicuspid, tricuspid, or quadricuspid, dysplastic thickening of the valve and fusion of the commissures.^[1,3] Forms of supravalvular obstructions include hourglass, diffuse and diaphragmatic. They may involve obstructions of the ascending aorta such as tubular hypoplasia and hypoplasia of the aortic arch as well as coarctation of the descending aorta.^[4,5]

All types of obstruction cause left ventricular hypertrophy, which creates an imbalance between the supply and demand for oxygen, leading to myocardial ischemia, heart failure and death if a precise diagnosis is not established and timely treatment instituted.

Echocardiography is a noninvasive technique of great value in identifying the site and type of aortic obstruction, in evaluating associated anomalies and their hemodynamic significance^[6,7,8,9] and in planning surgical correction.^[10] Knowledge of the morphological details of each obstructive type constitutes the basis for correctly interpreting the diagnostic images and making clinical decisions. The aim of this study was to correlate the echocardiographic images of patients with different types of aortic obstruction with those of equivalent anatomic specimens from the collection of specimens in the Department of Embryology of the Instituto Nacional de Cardiología Ignacio Chávez.

Cardiovasc Ultrasound. 2006;4(1) © 2006 Espinola-Zavaleta et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Cite this: Aortic Obstruction: Anatomy and Echocardiography - Medscape - Sep 29, 2006.

Echocardiographic Findings
Type	Pathology	No. of Patients	Percent
Valvular 36 (64.3 %)	Bicuspid aorta	31	55.3
	Tricuspid aorta	2	3.6
	Quadricuspid aorta	2	3.6
	Bicuspid aorta and coarctation	1	1.8
Supravalvular 20 (35.7%)	Fibrous ring (hourglass)	1	1.8
	Tubular hypoplasia of the ascending aorta	1	1.8
	Hypoplasia of the aortic arch	1	1.8
	Coarctation of the aorta	17	30.3
Total		56	100

Anatomopathological Findings
Type	Pathology	No. of patients	Percent
Valvular 21 (52.5 %)	Bicuspid aorta	20	50
Valvular 21 (52.5 %)	Quadricuspid aorta	1	2.5
Supravalvular 19 (47.5 %)	Fibrous ring (hourglass)	3	7.5
	Tubular hypoplasia of the ascending aorta	3	7.5
	Hypoplasia of the aortic arch	5	12.5
	Coarctation of the aorta	8	20
Total		40	100

Echocardiographic Findings
Type	Pathology	No. of Patients	Percent
Valvular 36 (64.3 %)	Bicuspid aorta	31	55.3
	Tricuspid aorta	2	3.6
	Quadricuspid aorta	2	3.6
	Bicuspid aorta and coarctation	1	1.8
Supravalvular 20 (35.7%)	Fibrous ring (hourglass)	1	1.8
	Tubular hypoplasia of the ascending aorta	1	1.8
	Hypoplasia of the aortic arch	1	1.8
	Coarctation of the aorta	17	30.3
Total		56	100

Anatomopathological Findings
Type	Pathology	No. of patients	Percent
Valvular 21 (52.5 %)	Bicuspid aorta	20	50
Valvular 21 (52.5 %)	Quadricuspid aorta	1	2.5
Supravalvular 19 (47.5 %)	Fibrous ring (hourglass)	3	7.5
	Tubular hypoplasia of the ascending aorta	3	7.5
	Hypoplasia of the aortic arch	5	12.5
	Coarctation of the aorta	8	20
Total		40	100

Commenting is limited to medical professionals. To comment please Log-in.

Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.