{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T08:36:23Z","timestamp":1790325383558,"version":"4.1.0"},"reference-count":90,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Imaging"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:p>There is continued interest in surgical repair of both the congenitally malformed aortic valve, and the valve with acquired dysfunction. Aortic valvar repair based on a geometric approach has demonstrated improved durability and outcomes. Such an approach requires a thorough comprehension of the complex 3-dimensional anatomy of both the normal and congenitally malformed aortic root. In this review, we provide an understanding of this anatomy based on the features that can accurately be revealed by contrast-enhanced computed tomographic imaging. We highlight the complimentary role that such imaging, with multiplanar reformatting and 3-dimensional reconstructions, can play in selection of patients, and subsequent presurgical planning for valvar repair. The technique compliments other established techniques for perioperative imaging, with echocardiography maintaining its central role in assessment, and enhances direct surgical evaluation. This additive morphological and functional information holds the potential for improving selection of patients, surgical planning, subsequent surgical repair, and hopefully the subsequent outcomes.<\/jats:p>","DOI":"10.1161\/circimaging.121.013134","type":"journal-article","created":{"date-parts":[[2021,11,8]],"date-time":"2021-11-08T04:00:57Z","timestamp":1636344057000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":46,"title":["Understanding the Aortic Root Using Computed Tomographic Assessment: A Potential Pathway to Improved Customized Surgical Repair"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8926-3752","authenticated-orcid":true,"given":"Justin T.","family":"Tretter","sequence":"first","affiliation":[{"name":"Heart Institute, Cincinnati Children\u2019s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, OH (J.T.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Izawa","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Department of Internal Medicine (Y.I.), Kobe University Graduate School of Medicine, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diane E.","family":"Spicer","sequence":"additional","affiliation":[{"name":"Heart Institute, Johns Hopkins All Children\u2019s Hospital, St. Petersburg, FL (D.E.S., J.A.Q.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenji","family":"Okada","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery (K.O.), Kobe University Graduate School of Medicine, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5163-9021","authenticated-orcid":true,"given":"Robert H.","family":"Anderson","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Centre, Biosciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom (R.H.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James A.","family":"Quintessenza","sequence":"additional","affiliation":[{"name":"Heart Institute, Johns Hopkins All Children\u2019s Hospital, St. Petersburg, FL (D.E.S., J.A.Q.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shumpei","family":"Mori","sequence":"additional","affiliation":[{"name":"UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA (S.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2017.09.019"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2019.09.019"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezaa285"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2016.08.017"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.11.010"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/ATVBAHA.114.302523"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0195-668x(03)00201-x"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.09.595"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2019-315157"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.118.004748"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcad.2020.04.010"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2020.3749"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1253\/circj.CJ-19-0652"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2018.06.032"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcdd7030030"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.semtcvs.2020.01.001"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.1253\/circj.CJ-20-0938"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2017.04.003"},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.1136\/heart.84.6.670"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.1002\/ca.23597"},{"key":"e_1_3_1_22_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezr093"},{"key":"e_1_3_1_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/0003-4975(94)00893-c"},{"key":"e_1_3_1_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2011.03.015"},{"key":"e_1_3_1_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2014.09.042"},{"key":"e_1_3_1_26_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezv059"},{"key":"e_1_3_1_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2014.12.034"},{"key":"e_1_3_1_28_2","doi-asserted-by":"publisher","DOI":"10.1002\/ca.23071"},{"key":"e_1_3_1_29_2","doi-asserted-by":"publisher","DOI":"10.1002\/ca.23340"},{"key":"e_1_3_1_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0967-2109(02)00018-2"},{"key":"e_1_3_1_31_2","first-page":"407","article-title":"Aortic root geometry: pattern of differences between leaflets and sinuses of Valsalva.","volume":"8","author":"Choo SJ","year":"1999","unstructured":"Choo, SJ, McRae, G, Olomon, JP, St George, G, Davis, W, Burleson-Bowles, CL, Pang, D, Luo, HH, Vavra, D, Cheung, DT, et al. Aortic root geometry: pattern of differences between leaflets and sinuses of Valsalva. J Heart Valve Dis. 1999;8:407\u2013415.","journal-title":"J Heart Valve Dis"},{"key":"e_1_3_1_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(94)70465-1"},{"key":"e_1_3_1_33_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezx456"},{"key":"e_1_3_1_34_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.39.9.1006"},{"key":"e_1_3_1_35_2","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jew146"},{"key":"e_1_3_1_36_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2019.02.001"},{"key":"e_1_3_1_37_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2018.08.004"},{"key":"e_1_3_1_38_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2006.04.032"},{"key":"e_1_3_1_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2012.06.053"},{"key":"e_1_3_1_40_2","doi-asserted-by":"publisher","DOI":"10.1177\/1556984519843909"},{"key":"e_1_3_1_41_2","doi-asserted-by":"publisher","DOI":"10.1114\/1.122"},{"key":"e_1_3_1_42_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2012.05.014"},{"key":"e_1_3_1_43_2","doi-asserted-by":"publisher","DOI":"10.1002\/ca.23462"},{"key":"e_1_3_1_44_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00392-016-0971-3"},{"key":"e_1_3_1_45_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12630-012-9819-0"},{"key":"e_1_3_1_46_2","doi-asserted-by":"publisher","DOI":"10.1111\/echo.13468"},{"key":"e_1_3_1_47_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2018.08.014"},{"key":"e_1_3_1_48_2","doi-asserted-by":"publisher","DOI":"10.1253\/circj.CJ-20-0135"},{"key":"e_1_3_1_49_2","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.3831-19"},{"key":"e_1_3_1_50_2","doi-asserted-by":"publisher","DOI":"10.1111\/echo.13729"},{"key":"e_1_3_1_51_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezz053"},{"key":"e_1_3_1_52_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2009.04.013"},{"key":"e_1_3_1_53_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2011.07.036"},{"key":"e_1_3_1_54_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2018.12.003"},{"key":"e_1_3_1_55_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2015.05.002"},{"key":"e_1_3_1_56_2","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2017-312390"},{"key":"e_1_3_1_57_2","volume-title":"Das Reizleitungssystem des Sa\u00a8ugetierherzens Jena","author":"Tawara S","year":"1906","unstructured":"Tawara, S. Das Reizleitungssystem des Sa\u00a8ugetierherzens Jena. Gustav Fischer; 1906."},{"key":"e_1_3_1_58_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2014.04.003"},{"key":"e_1_3_1_59_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jelectrocard.2017.03.004"},{"key":"e_1_3_1_60_2","doi-asserted-by":"publisher","DOI":"10.1007\/s13239-019-00441-2"},{"key":"e_1_3_1_61_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2017.01.009"},{"key":"e_1_3_1_62_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-021-02594-1"},{"key":"e_1_3_1_63_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.semtcvs.2020.02.031"},{"key":"e_1_3_1_64_2","doi-asserted-by":"publisher","DOI":"10.1136\/openhrt-2018-000972"},{"key":"e_1_3_1_65_2","doi-asserted-by":"publisher","DOI":"10.1111\/joa.12611"},{"key":"e_1_3_1_66_2","doi-asserted-by":"publisher","DOI":"10.1002\/ca.23599"},{"key":"e_1_3_1_67_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2018.04.029"},{"key":"e_1_3_1_68_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2021.07.065"},{"key":"e_1_3_1_69_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2016.11.020"},{"key":"e_1_3_1_70_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2015.05.010"},{"key":"e_1_3_1_71_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2019.05.056"},{"key":"e_1_3_1_72_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.028352"},{"key":"e_1_3_1_73_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.934679"},{"key":"e_1_3_1_74_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezz033"},{"key":"e_1_3_1_75_2","doi-asserted-by":"publisher","DOI":"10.4065\/74.1.14"},{"key":"e_1_3_1_76_2","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jeaa420"},{"key":"e_1_3_1_77_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2015.07.058"},{"key":"e_1_3_1_78_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2007.01.039"},{"key":"e_1_3_1_79_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcad.2020.06.006"},{"key":"e_1_3_1_80_2","doi-asserted-by":"publisher","DOI":"10.1017\/S1047951114001942"},{"key":"e_1_3_1_81_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezz193"},{"key":"e_1_3_1_82_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0003-4975(97)00524-9"},{"key":"e_1_3_1_83_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2008.06.073"},{"key":"e_1_3_1_84_2","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jew057"},{"key":"e_1_3_1_85_2","doi-asserted-by":"publisher","DOI":"10.1253\/circj.68.439"},{"key":"e_1_3_1_86_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12574-012-0148-7"},{"key":"e_1_3_1_87_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2009.06.106"},{"key":"e_1_3_1_88_2","doi-asserted-by":"publisher","DOI":"10.3904\/kjim.2018.109"},{"key":"e_1_3_1_89_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2019.01.045"},{"key":"e_1_3_1_90_2","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jeu162"},{"key":"e_1_3_1_91_2","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jev343"}],"container-title":["Circulation: Cardiovascular Imaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCIMAGING.121.013134","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,12]],"date-time":"2024-05-12T22:36:27Z","timestamp":1715553387000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCIMAGING.121.013134"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11]]},"references-count":90,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2021,11]]}},"alternative-id":["10.1161\/CIRCIMAGING.121.013134"],"URL":"https:\/\/doi.org\/10.1161\/circimaging.121.013134","relation":{},"ISSN":["1941-9651","1942-0080"],"issn-type":[{"value":"1941-9651","type":"print"},{"value":"1942-0080","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11]]},"assertion":[{"value":"2021-11-08","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e013134"}}