{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T22:37:05Z","timestamp":1789425425375,"version":"build-2803163510"},"reference-count":21,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:00:00Z","timestamp":1777334400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objectives: Several measurement techniques have been proposed to address the non-circular geometry of the aortic root. The Laplace diameter metric incorporates the cloverleaf anatomy of the aortic root and is derived via measurement of sinus-to-commissure lengths with subsequent doubling of the largest radius from the center. This study compares the conventional sinus-to-sinus with the novel Laplace method for sizing the aortic root and quantifying its implication on surgical decision-making. Methods: Patients undergoing surveillance at a high-volume aortic center were categorized by aortic root morphology as nondilated, non-syndromic dilated, bicuspid aortic valve and Marfan syndrome. Aortic root diameters by sinus-to-sinus and Laplace diameter methods were measured on computed tomography, compared using paired t-tests, and correlated using Spearman rank coefficients. Results: Of the 1297 patients assessed, 530 were included in the final analysis (nondilated n = 113, non-syndromic dilated n = 347, bicuspid aortic valve n = 50, Marfan syndrome n = 17). Aortic root diameters were significantly larger by Laplace than sinus-to-sinus diameter across all groups (sinus-to-sinus: 1.9 \u00b1 5.5 mm; Laplace: 44.9 \u00b1 7.0 mm; 95% confidence interval 2.72\u20133.34; p &lt; 0.0001). Although Laplace and sinus-to-sinus diameter were correlated (Spearman r = 0.6789, 95% CI 0.6\u20130.7; p &lt; 0.0001), the relationship was non-linear (R2 = 0.492). Laplace diameter increased the proportion of patients meeting surgical thresholds (2022 AHA\/ACC guidelines) versus sinus-to-sinus: nondilated 0% vs. 1.77%, non-syndromic dilated 4.9% vs. 25.1%, bicuspid aortic valve 10.0% vs. 26.0%, and Marfan syndrome 23.5% vs. 52.9%. Conclusions: On average, Laplace diameter exceeded sinus-to-sinus diameter by 3 mm and would extend surgical eligibility to an additional 21% of patients under current guidelines.<\/jats:p>","DOI":"10.3390\/jcm15093349","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T09:55:39Z","timestamp":1777370139000},"page":"3349","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Strategies for Aortic Root Measurement in Patients Undergoing Surveillance for Thoracic Aortic Disease"],"prefix":"10.3390","volume":"15","author":[{"given":"Asama","family":"Rana","sequence":"first","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT 06510, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4954-4685","authenticated-orcid":false,"given":"Irbaz","family":"Hameed","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT 06510, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sedem","family":"Dankwa","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT 06510, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danial","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT 06510, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cameron","family":"Best","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT 06510, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7108-1866","authenticated-orcid":false,"given":"Sem","family":"Asmelash","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT 06510, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4327-5827","authenticated-orcid":false,"given":"Jose","family":"Anzueto","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT 06510, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sriharsha","family":"Talapaneni","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT 06510, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michela","family":"Cupo","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT 06510, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0983-2615","authenticated-orcid":false,"given":"Akbar","family":"Bazarbaev","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT 06510, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiv","family":"Verma","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT 06510, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6157-0881","authenticated-orcid":false,"given":"Chanseo","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT 06510, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Titilayo","family":"Oden Shobayo","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT 06510, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prashanth","family":"Vallabhajosyula","sequence":"additional","affiliation":[{"name":"Yale Aortic Institute, Yale Pulmonary Thromboendarterectomy Program, Division of Cardiac Surgery, Yale School of Medicine, 330 Cedar Street BB204, New Haven, CT 06520, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1093\/ehjci\/jez012","article-title":"Normal values of aortic dimensions assessed by multidetector computed tomography in the Copenhagen General Population Study","volume":"20","author":"Pham","year":"2019","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e334","DOI":"10.1161\/CIR.0000000000001106","article-title":"2022 ACC\/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association\/American College of Cardiology Joint Committee on Clinical Practice Guidelines","volume":"146","author":"Isselbacher","year":"2022","journal-title":"Circulation"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/j.cpcardiol.2008.01.004","article-title":"Thoracic Aortic Aneurysm: Reading the Enemy\u2019s Playbook","volume":"33","author":"Elefteriades","year":"2008","journal-title":"Curr. Probl. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1126\/science.1253026","article-title":"Dysfunctional Mechanosensing in Aneurysms","volume":"344","author":"Humphrey","year":"2014","journal-title":"Science"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.jacc.2020.03.084","article-title":"Discrepancies in Measurement of the Thoracic Aorta","volume":"76","author":"Elefteriades","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1345","DOI":"10.1007\/s10554-023-02847-5","article-title":"Extended law of laplace for measurement of the cloverleaf anatomy of the aortic root","volume":"39","author":"Ban","year":"2023","journal-title":"Int. J. Cardiovasc. Imaging"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.echo.2014.11.015","article-title":"Multimodality Imaging of Diseases of the Thoracic Aorta in Adults: From the American Society of Echocardiography and the European Association of Cardiovascular Imaging","volume":"28","author":"Goldstein","year":"2015","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"792","DOI":"10.1016\/j.echo.2019.02.001","article-title":"Two-Dimensional Imaging of a Complex Three-Dimensional Structure: Measurements of Aortic Root Dimensions","volume":"32","author":"Tretter","year":"2019","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1111\/echo.13468","article-title":"The differences between bisecting and off-center cuts of the aortic root: The three-dimensional anatomy of the aortic root reconstructed from the living heart","volume":"34","author":"Mori","year":"2017","journal-title":"Echocardiography"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/j.jcmg.2015.06.023","article-title":"The Need for Standardized Methods for Measuring the Aorta","volume":"9","author":"Asch","year":"2016","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1517","DOI":"10.1016\/0006-2952(75)90029-5","article-title":"Comparison between procaine and isocarboxazid metabolism in vitro by a liver microsomal amidase-esterase","volume":"24","author":"Moroi","year":"1975","journal-title":"Biochem. Pharmacol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"87","DOI":"10.4103\/0974-2700.110752","article-title":"Etiology of out-of-hospital cardiac arrest diagnosed via detailed examinations including perimortem computed tomography","volume":"6","author":"Moriwaki","year":"2013","journal-title":"J. Emerg. Trauma Shock"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1002\/ca.24165","article-title":"Aortic root morphometry revisited\u2014Clinical implications for aortic valve interventions","volume":"37","author":"Dudkiewicz","year":"2024","journal-title":"Clin. Anat."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1210","DOI":"10.1016\/S0003-4975(02)04711-2","article-title":"Effect of aneurysm on the tensile strength and biomechanical behavior of the ascending thoracic aorta","volume":"75","author":"Vorp","year":"2003","journal-title":"Ann. Thorac. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/j.jcmg.2007.12.006","article-title":"Noninvasive Evaluation of the Aortic Root With Multislice Computed Tomography","volume":"1","author":"Tops","year":"2008","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_16","first-page":"450","article-title":"2020 ACC\/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"143","author":"Otto","year":"2021","journal-title":"Circulation"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1104","DOI":"10.1001\/jama.2011.1286","article-title":"Incidence of Aortic Complications in Patients With Bicuspid Aortic Valves","volume":"306","author":"Michelena","year":"2011","journal-title":"JAMA"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e240229","DOI":"10.1148\/radiol.240229","article-title":"Quantification of Aortic Valve Fibrotic and Calcific Tissue from CTA: Pro-spective Comparison with Histology","volume":"312","author":"Grodecki","year":"2024","journal-title":"Radiology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.echo.2014.10.003","article-title":"Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging","volume":"28","author":"Lang","year":"2015","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1016\/j.jacc.2009.08.084","article-title":"Thoracic Aortic Aneurysm","volume":"55","author":"Elefteriades","year":"2010","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1016\/j.jtcvs.2018.07.053","article-title":"A comparison of aortic root measurements by echocardiography and computed tomography","volume":"157","author":"Plonek","year":"2019","journal-title":"J. Thorac. Cardiovasc. 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