Sinus Of Valsalva Research Articles

A Case Report of Primary Angioplasty: The Triple Whammy!

Congenital anomalies involving coronary artery origin are rare, with an incidence of 0.24%–1.3%. We present a case of inferior wall ST-elevation myocardial infarction in which an emergency coronary angiogram showed occlusion of the right coronary artery. However, we were unable to cannulate the left main coronary artery during the event. Interpretation of the infarct-related artery was complicated by the right arm-left arm lead reversal in electrocardiogram, adding to the dilemma in localizing the culprit vessel, namely right versus left circumflex coronary artery-related myocardial infarction. A computed tomography coronary angiogram subsequently showed the left main coronary artery having abnormal origin from the right sinus of Valsalva with inter-arterial course and no lesions in the left circumflex.

Morphometry and topography of the coronary ostia in the dog.

The purpose of this study was to perform a morphometric examination of the coronary ostia, including their location in the area of the aortic sinuses, and to describe variations in ostia structure in the domestic dog. The study was conducted on the hearts of 91 pedigree dogs of both sexes, aged 1 to 18 years (median 9 years), with a body weight from 1.2 to 65 kg (median 20.7 kg). Morphometric examinations of the coronary ostia were performed in the studied individuals, and the location of the structures in relation to the intercommissural lines was determined. Three types of location of the coronary ostia were distinguished, i.e. below the intercommissural line (type I), on the intercommissural line (type II), and above the intercommissural line (type III). In the studied dogs, the most common location of the ostia was type I - found in the left coronary artery of 74/91 dogs (81%) and in the right coronary artery of 42/91 dogs (46%). Morphological variations were shown in 36/91 dogs (40%) in the structure of the coronary ostia, including the presence of accessory ostia. The most common variation was the presence of an accessory ostium near the ostium of the right coronary artery, which was found in 28/91 dogs (31%). The results may be useful in developing standards for procedures to replace the whole or part of the aortic valve and repair the coronary artery.

Aortic Valve Dysfunction and Aortopathy Based on the Presence of Raphe in Patients with Bicuspid Aortic Valve Disease.

(1) Background: To identify the association between the presence or absence of a raphe and aortic valve dysfunction, as well as the presence of aortopathy in patients with a bicuspid aortic valve (BAV); (2) Methods: This retrospective study enrolled 312 participants (mean (SD) age, 52.7 (14.3) years; 227 men (72.8%)) with BAV. The BAVs were divided into those with the presence (raphe+) or absence (raphe-) of a raphe. Valvular function was classified as normal, aortic regurgitation (AR), or aortic stenosis (AS) using TTE. The pattern of BAV aortopathy was determined by the presence of dilatation at the sinus of Valsalva and the middle ascending aorta using CCT; (3) Results: BAVs with raphe+ had a higher prevalence of AR (148 (79.5%) vs. 48 (37.8%), p < 0.001), but a lower prevalence of AS (90 (48.6%) vs. 99 (78.0%), p < 0.001) compared with those with raphe-. The types of BAV aortopathy were significantly different (p = 0.021) according to those with BAV-raphe+ and BAV-raphe-; (4) Conclusions: The presence of a raphe was significantly associated with a higher prevalence of AR, but a lower prevalence of AS and combined dilatation of the aortic root and middle ascending aorta. The presence of a raphe was an independent determinant of AR.

Variable clinical expression of a Belgian TGFB3 founder variant suggests the presence of a genetic modifier.

Background: TGFB3 variants cause Loeys-Dietz syndrome type 5, a syndromic form of thoracic aortic aneurysm and dissection. The exact disease phenotype is hard to delineate because of few identified cases and highly variable clinical representation. Methodology: We provide the results of a haplotype analysis and a medical record review of clinical features of 27 individuals from 5 different families, originating from the Campine region in Flanders, carrying the NM_003239.5(TGFB3):c.787G>C p.(Asp263His) likely pathogenic variant, dbSNP:rs796051886, ClinVar:203492. The Asp263 residue is essential for integrin binding to the Arg-Gly-Asp (RGD) motif of the TGFβ3-cytokine. Results: The haplotype analysis revealed a shared haplotype of minimum 1.92Mb and maximum 4.14Mb, suggesting a common founder originating >400years ago. Variable clinical features included connective tissue manifestations, non-aneurysmal cardiovascular problems such as hypertrophic cardiomyopathy, bicuspid aortic valve, mitral valve disease, and septal defects. Remarkably, only in 4 out of the 27 variant-harboring individuals, significant aortic involvement was observed. In one family, a 31-year-old male presented with type A dissection. In another family, the male proband (65years) underwent a Bentall procedure because of bicuspid aortic valve insufficiency combined with sinus of Valsalva of 50mm, while an 80-year-old male relative had an aortic diameter of 43mm. In a third family, the father of the proband (75years) presented with ascending aortic aneurysm (44mm). Conclusion: The low penetrance (15%) of aortic aneurysm/dissection suggests that haploinsufficiency alone by the TGFB3 variant may not result in aneurysm development but that additional factors are required to provoke the aneurysm phenotype.

Aortic sinus aneurysm invading ventricular septum and dissection caused by Behcet’s disease: a case report and literature review

Few case reports have mentioned the aortic sinus aneurysm invading ventricular septum and dissection caused by Behcet’s disease. Here, we reported a 36-year-old male patient with an aortic sinus aneurysm invading the ventricular septum and dissection caused by Behcet’s disease, who manifested as recurrent chest tightness and shortness of breath. Cardiac ultrasound showed the rupture of the right aortic sinus and the formation of ventricular septal dissection. Ascending aortic valve prosthesis replacement, mitral valvuloplasty with ring implantation and tricuspid valvuloplasty were performed. Postoperatively, he was treated with hormones, hydroxychloroquine sulfate, mycophenolate mofetil tablets, thalidomide and warfarin, and his symptoms were relieved. This is a rare case easily being misdiagnosed and missed, early diagnosis and in-time treatment are crucial to avoid surgical complications. The diagnostic and therapeutic approaches of this patient were reported and related literature was reviewed in this case report.

David V procedure and hemiarch replacement in a patient with Loeys-Dietz-Syndrome and beta thalassemia minor: a case report

We report the case of a 36-year-old European female patient presenting with a sinus valsalva aneurysm of 47 mm with moderate aortic regurgitation. Additionally, an aneurysm of the brachiocephalic trunk and multiple aneurysms of the right internal mammary artery were identified. Previous medical history included Loeys-Dietz syndrome (LDS) Type RII due to a TGF-beta receptor mutation, and beta thalassemia minor with a baseline hemoglobin of 9,3 g/dL on admission.Reconstruction of the aortic root and hemiarch replacement was performed in circulatory arrest under moderate hypothermia. During surgery, hypothermia was required as part of the cerebral protection strategy. We aim to highlight special considerations and discuss the effects of cooling, rewarming and the use of cardiopulmonary bypass (CPB) during extensive surgery in a patient with LDS and beta thalassemia minor.

Transcatheter closure of a ruptured sinus of valsalva: a systematic review of the literature.

Ruptured sinus of Valsalva (RSOV) is a rare pathology, and current data regarding its symptoms, anatomy, associated pathologies, and appropriate therapeutic approaches are scarce. Transcatheter closure (TCC) has been performed in multiple cases; however, the information on its success rate and complications is limited. Two independent reviewers performed an advanced search based on inclusion criteria on Scopus, PubMed, and Embase from January 1985 through July 2022. The main search terms were "Sinus of Valsalva", "Rupture/Aneurysm", and "Transcatheter/Catheter/Device". Totally, 1,017 relevant articles from the 3 databases were retrieved. After the final review and appraisal, 94 articles describing 407 patients who underwent the TCC of RSOV were included. Males comprised 65% of the studied patients, and the average age was 34.5 years. The total success rate of TCC was 95.6%. Forty-nine patients (12%) developed complications, the most significant of which were sustained residual shunts in 7 patients (1.7%), substantial new onset or progression of aortic insufficiency in 6 (1.5%), and RSOV recurrence in 6 (1.5%). Post-interventional mortality was reported in only 2 patients (0.5%). The present study is the first systematic review of available data regarding the TCC of RSOV principally comprising case series and case reports. Although TCC seems a good option, precise patient selection is mandatory.

Three-step surgical management algorithm for annular rupture in transcatheter aortic valve replacement

ObjectiveWhereas transcatheter aortic valve replacement is widely implemented, annular rupture is a devastating complication and could be highly mortal. However, owing to its rare incidence, the optimal treatment algorithm has not been established. Thus, we evaluated the feasibility and effectiveness of a 3-step algorithm to treat annulus rupture. MethodsFrom 2009 to 2022, 8 patients of 1083 transcatheter aortic valve implantation (0.8%) developed annulus rupture and were treated with the three-step algorithm. The algorithm was composed of a first step (pericardial drainage and protamine neutralization with blood pressure control), second step (manual hemostatic compression via full/partial sternotomy), and a third step (conservative treatment or radical surgical correction). ResultsThe median age at the procedure was 85 (78-88) years and 7 female patients were included in this study. Two (25%) patients had end-stage renal failure under hemodialysis, and median Society of Thoracic Surgeons score was 8.9% (2.1%-23.2%). The implanted transcatheter heart valves (THVs) were 7 balloon-expandable THVs and 1 self-expandable THV with balloon postdilatation. Under this strategy, 8 (100%) patients underwent pericardial drainage as first step and 5 patients achieved hemostasis. Of these, patient 1 demonstrated bleeding from left sinus of Valsalva and required a Bentall procedure. Although the etiology of this phenomenon was not investigated by contrast-enhanced computed tomography, it might be derived from pseudoaneurysm rupture or delayed annular rupture. In 2 patients, the second step treatment was needed for hemostasis. Third-step treatment was conducted in 1 patient. Postoperatively, 6 patients could be discharged without critical complications whereas 2 patients died during the hospitalization. There were no other complications during the followed-up (584 [7-1614]) days. ConclusionsIn accordance with the three-step algorithm, 6 patients, including those with high-risk or inoperative status, survived.

Occult deterioration of an aortic annular abscess: how do we diagnose a pseudoaneurysm periaortic valve? A case report

BackgroundInfectious endocarditis (IE) is a disease caused by the colonization of toxic microorganisms on the endocardium of heart valves [1]. Although much progress has been made in the diagnosis and treatment of IE, its complications, such as annular abscesses [2], still have a high mortality rate. In this case, we describe a patient with infective endocarditis complicated by occult deteriorated aortic annular abscess.Case presentationA 44-year-old man was admitted due to weakness of his right limbs and unclear speech for 10 h. He had recurrent fevers for 1 month before admission. Transthoracic echocardiography showed a mix-echoic vegetation attached to the bicuspid aortic valve, moderate aortic regurgitation and a possible aortic annular abscess. Blood cultures were negative and empiric antibiotic therapy was begun. The patient did not have fever again and seem to be clinically improved. However, follow-up transesophageal echocardiography revealed a large periaortic abscess led to aortic sinus pseudoaneurysm. The patient underwent mechanical prosthetic valve replacement and annulus reconstruction successfully. Perivalvular abscess may be insidious deterioration in patients who seem to be clinically improved, which requires us to pay more attention.DiscussionOccult deterioration of an aortic annular abscess is rare and more attention should be paid. Re-evaluation of echocardiography is required even if the patient’s symptoms improve.

Valve-Sparing Neo-Aortic Root Replacement for Neo-Aortic Root Dilatation 20 Years after Arterial Switch Operation for Transposition of the Great Arteries: A Case Report.

A 25-year-old man returned to Seoul National University Children's Hospital with mild dyspnea on exertion. He had undergone an arterial switch operation at 1 month after birth to correct a complete transposition of the great arteries and a ventricular septal defect. When the patient was 15 years old, dilatation of the neo-aortic sinus and annulus was first identified; since then, it had gradually increased. Given the young age of the patient and the degree of aortic regurgitation (AR), which was mild to moderate, we opted to perform a valve-sparing neo-aortic root replacement with aortic valve repair. Postoperative echocardiography showed successful reductions in the sizes of the aortic sinus and annulus, with only mild AR remaining.

Anatomic feasibility of a modular Endo-Bentall stent graft system for type A aortic dissection

ObjectiveThe implementation of thoracic endovascular aortic repair in patients with type A aortic dissection has been strictly constrained due to the pulsatile movement and distensibility and the insufficient length of landing zones on ascending aorta. The most prevalent anatomical limitation is the insufficient length of proximal and distal landing zones. We propose a modularly designed Endo-Bentall stent graft system to broaden the scope of thoracic endovascular aortic repair in the ascending aorta by covering intimal tears in the aortic root and ascending aorta and reconstructing coronary arteries. This study was conducted to assess the anatomical feasibility of a novel stent graft design. MethodsIn this study, we included 152 patients with type A aortic dissection for image measurement and analysis. All computed tomography angiography images were assessed on a 3mensio Workstation version 10.2 (3mensio Medical Imaging B.V.) utilizing the centerline method. We compared the diameters and lengths at various planes in relation to the proposed anatomical criteria for the modular Endo-Bentall stent graft system. ResultsThe patients were predominantly male (67.1%), with a median age of 56.5 years (interquartile range, 50.0-65.0 years). Among all aortic dissections, 91.5% extended proximally to the sinotubular junction, whereas only 8.6% were restricted to the tubular ascending aorta. The median perimeter-derived diameter of the aortic annulus was 24.1 mm. The median maximum aortic diameter at the sinotubular junction and brachiocephalic trunk were 44.6 mm and 43.5 mm, respectively. The median height of the left coronary artery, right coronary artery, and sinus of Valsalva were 12.7 mm, 16.7 mm, and 28.4 mm, respectively. After applying exclusion criteria, 66.4% of all patients were anatomically eligible for the modular Endo-Bentall stent graft system. A total of 85.1% of patients were suitable for stent grafts with lengths of 70 mm, 80 mm, or 90 mm. Both antegradely and retrogradely tapered stent grafts were required, according to the diameter differences between the STJ and brachiocephalic trunk. ConclusionsUtilizing the modular Endo-Bentall stent-graft design, approximately two-thirds of patients with type A aortic dissection are anatomically eligible for endovascular repair. Further animal studies are required to optimize the device design.

Severe Anemia in a Case with Chronic Kidney Disease and Mechanical Heart Valve

Introduction: Infective endocarditis is a serious disease with high morbidity and mortality, especially when associated with renal failure. Anemia is a common finding in chronic kidney disease. Here, we present a case of renal failure and severe anemia with a complicated mechanical heart valve infection with a Delayed diagnosis. Case Presentation: A 68-year-old male patient with a history of chronic kidney disease and metallic aortic valve surgery presented with fever, severe anemia, and about 10-kg weight loss that eventually revealed infective endocarditis in echocardiography with significant valvular leakage, pseudoaneurysm of mitral-aortic intervalvular fibrosa and a fistula to left ventricular outflow tract and sinus Valsalva of the aorta. Conclusions: This case report indicates that anemia, renal failure, and fever of unknown origin can be one of the diagnostic signs of endocarditis. It is important to consider infectious endocarditis in high-risk patients because late diagnosis greatly increases mortality, serious complications, and morbidity.

Native Valve Infective Endocarditis Associated with Ruptured Right Sinus of Valsalva: A Case Report

Endocarditis is defined as an infection of the cardiac endothelium. The incidence occurs from 2 to 10 cases per 100,000 people/year. Cardiovascular complications, including cardiac arrest, cardiogenic shock, myocardial infarction, acute heart failure, and heart block. The case of a 51-year-old male patient with fever, asthenia, adynamia, and chills is presented, evolving to shock data to determine the origin, requiring management with vasopressor, a diagnostic protocol with transthoracic echocardiogram is performed where calcified aortic valve and mass attached to the valve ring and image suggestive of abscess at the level of the sinuses of Valsalva are observed. Transesophageal echocardiogram, in addition to the vegetation previously described and the abscess in the mitro-aortic continuity, tricuspid valve lesion with rupture of the sinus of Valsalva. Consultation was requested for cardiothoracic surgery with aortic valve replacement due to a N23 mechanical valve, with closure of the right sinus of Valsalva ruptured to the right ventricle infective endocarditis of the aortic and tricuspid valve with clinical improvement if any eventualities occurred. Rupture of the sinus of Valsalva with fistulization towards lower-pressure cavities (generally the right atrium and ventricle) is probably the most frequent form of presentation. Accurate diagnosis of complicated infective endocarditis means the difference between a good evolution and a poor prognosis.

Rare case of single left coronary artery in a Japanese cadaver.

A single left coronary artery with a single orifice in the left aortic sinus was observed during anatomical practice in an 81-year-old male Japanese cadaver. The single left coronary artery bifurcated into the anterior interventricular branch (IVa) and circumflex (CXa) branches. The IVa descended into the anterior interventricular sulcus to supply the apex of the heart, leaving a branch that traversed the upper part of the infundibulum to supply the anterior upper region of the right ventricle. The CXa curved leftward in the atrioventricular sulcus to reach the posterior surface, after which it continued to emerge into the anterior surface. The vascular running pattern showed that CXa directly supplied blood to the upper right ventricle (but not the conus branch), with three branches connected to the apex. The atrial arteries showed no anomalous distribution patterns. These findings are useful during surgical procedures, including cardiac catheterization.

Clinical Outcomes in Adult Patients With an Anomalous Right Coronary Artery from the Left Sinus of Valsalva

An anomalous origin of the right coronary artery from the opposite sinus of Valsalva with an intramural course (R-ACAOS-IM) may cause sudden cardiac death in children and adolescents. However, the natural history and management of patients in whom this anomaly is detected later during adulthood remains uncertain. The goals of this study were to assess the impact of an R-ACAOS-IM on the clinical outcomes in an adult population and to determine if adult patients with this anomaly who do not have significant coronary artery disease (CAD) can be managed safely without surgical intervention. A database review identified patients aged >35 years with anomalous coronary arteries diagnosed by cardiac catheterization or coronary computed tomography angiography. The outcomes of patients with R-ACAOS-IM were compared with patients with anomalous left circumflex coronary arteries with retroaortic course (LCx-RA) (an anomaly not associated with ischemic events). The primary outcome was all-cause mortality. The study population consisted of 185 patients aged 59 ± 12 years. Clinical characteristics were similar in the R-ACAOS-IM (n=88) and LCx-RA (n=97) groups. At a follow-up of 6.6 ± 4.5years, there was no difference in mortality (hazard ratio 0.64, 95% confidence interval 0.32 to 1.28, p=0.20) when adjusted for gender, age, and CAD. A subgroup analysis of 88 patients with no obstructive CAD managed nonoperatively found no difference between the LCx and R-ACAOS-IM groups in mortality (hazard ratio 2.45, 95% confidence interval 0.45 to 13.40, p=0.30). There was no significant difference between the 2 groups in the composite outcome of death, nonfatal myocardial infarction, or survived cardiac arrest. The outcome of adult patients who have anomalous R-ACAOS-IM are similar to patients who have anomalous LCx-RA with a known benign course. In conclusion, these results suggest that most patients who survive this anomaly into adulthood may be managed conservatively without intervention.

Transcatheter aortic valve implantation in a patient with anomalous right coronary artery originating from the left aortic sinus with interarterial course.

Transcatheter aortic valve implantation in a patient with anomalous right coronary artery originating from the left aortic sinus with interarterial course.

Complicated catheter ablation of premature ventricular contractions from the left sinus of Valsalva in a young female. Case presentation.

Idiopathic premature ventricular complexes (PVCs) are usually benign and are often treated conservatively. Data regarding radiofrequency catheter ablation (RFA) of PVCs from the aortic sinus of Valsalva are spare. Furthermore, there are limited data regarding complications and their solutions during RFA of PVCs from the aortic sinus of Valsalva. Here we describe a clinical case of symptomatic PVCs in a 27yrold young woman with reduced exercise tolerance and dyspnea. The patient had taken anti-arrhythmic group Ic, II, and III drugs with no significant effect. Successful catheter ablation of PVCs from the left sinus of Valsalva was complicated by acute occlusion of the left main coronary artery (LCA) followed by polymorphic ventricular tachycardia and ventricular fibrillation. Cardioversion and intravenous antiarrhythmic administration restored the sinus rhythm. The LCA was stented with a bioresorbable Magmaris stent with the support of extracorporeal membrane oxygenation that was required due to severe hypotension and ineffectiveness of vasopressors. After the procedure, a favorable angiographic effect was noted. The result of stenting was monitored with IVUS intravascular navigation. The patient was discharged in a satisfactory condition on the 10th day after the procedure. Special attention should be applied to prevent complications and to careful patient selection for RFA in the left sinus of Valsalva, and care must be taken to avoid injury to the LCA. Timely and correct procedures can result in patient survival even after acute LCA injury and occlusion.

Correction to: Sensitivity and Specificity of Transthoracic Echocardiography in Diagnosing the Presence of the Anomalous Origin of Left Circumflex Coronary Artery From the Right Sinus of Valsalva in an Adult Population.

Correction to: Sensitivity and Specificity of Transthoracic Echocardiography in Diagnosing the Presence of the Anomalous Origin of Left Circumflex Coronary Artery From the Right Sinus of Valsalva in an Adult Population.

Thoracic aorta diameters in Marfan patients: Intraindividual comparison of 3D modified relaxation-enhanced angiography without contrast and triggering (REACT) with transthoracic echocardiography

ObjectiveTo compare the measurement of aortic diameters using a novel flow-independent MR-Angiography (3D modified Relaxation-Enhanced Angiography without Contrast and Triggering (modified REACT)) and transthoracic echocardiography (TTE) in Marfan syndrome (MFS) patients. Material and methodsThis retrospective, single-center analysis included 46 examinations of 32 MFS patients (mean age 37.5 ± 11.3 years, 17 women, no prior aortic surgery) who received TTE and 3D modified REACT (ECG- and respiratory-triggering, Compressed SENSE factor 9 for acceleration of image acquisition) of the thoracic aorta. Aortic diameters (sinus of Valsalva (SV), sinotubular junction (STJ), and ascending aorta (AoA)) were independently measured by two cardiologists in TTE (leading-edge) and two radiologists in modified REACT (inner-edge, using multiplanar reconstruction). Intraclass correlation coefficient, Bland-Altman analyses, and Pearson's correlation (r) were used to assess agreement between observers and methods. ResultsInterobserver correlation at the SV, STJ, and AoA were excellent for both, TTE (ICC = 0.95–0.98) and modified REACT (ICC = 0.99–1.00). There was no significant difference between TTE and modified REACT for diameters measured at the SV (39.24 ± 3.24 mm vs. 39.63 ± 3.76 mm; p = 0.26; r = 0.78) and the STJ (35.16 ± 4.47 mm vs. 35.37 ± 4.74 mm; p = 0.552; r = 0.87). AoA diameters determined by TTE were larger than in modified REACT (34.29 ± 5.31 mm vs. 30.65 ± 5.64 mm; p < 0.01; r = 0.74). The mean scan time of modified REACT was 05:06 min ± 02:47 min, depending on the patient's breathing frequency and heart rate. ConclusionsBoth TTE and modified REACT showed a strong correlation for all aortic levels; however, at the AoA, diameters were larger using TTE, mostly due to the limited field of view of the latter with measurements being closer to the aortic valve. Given the excellent interobserver correlation and the strong agreement with TTE, modified REACT represents an attractive method to depict the thoracic aorta in MFS patients.

Aortic root/left ventricular diameters golden ratio in competitive athletes

BackgroundThe athlete's heart is a well-known phenomenon characterized by a harmonic remodelling that affects the cardiac chambers. However, whether mild-to-moderate aortic dilatation can be considered normal in athletes is debated. This study aimed to evaluate the ratio between left ventricular (LV) size and aortic dimensions, reporting the normal values of the ratio between the aortic root diameters at the level of the sinuses of Valsalva and LV diameters (AoD/LVEDD ratio) in a wide cohort of competitive athletes. Materials and methodsCompetitive athletes were compared with sedentary subjects and patients with aortic dilatation. 1901 subjects who underwent echocardiography from 2019 to 2022 were retrospectively enrolled: 993 athletes (74% males, mean age 26 ± 7 years), 410 sedentary (74.1% males, mean age 29 ± 11 years) and 498 patients with aortic dilatation (74.3% males, mean age 56 ± 7 years). ResultsPatients with aortic dilatation had both an absolute (39.2 ± 2.4 mm) and indexed (19.4 ± 2.2 mm/m2) aortic diameter larger than athletes (30.6 ± 3.2 mm; 16.1 ± 1.5 mm/m2, p < 0.05) and sedentary subjects (30.5 ± 3.1 mm; 16.5 ± 1.6 mm/m2, p < 0.05), with no differences between athletes and sedentary subjects. The AoD/LVEDD ratio was lower in athletes (0.59 ± 0.06) compared to controls (0.65 ± 0.05, p < 0.05) and patients with aortic dilatation (0.81 ± 0.06, p < 0.05). The patients with aortopathy had the lowest LVEDD/AoD ratio, while competitive athletes had the highest, with values of 1.71 ± 0.16 in the latter (overall p value<0.001). ConclusionsIn this study, we reported the AoD/LVEDD and LVEDD/AoD ratio values in a cohort of healthy athletes, additional parameters that could help confirm the harmonic remodelling in the athlete's heart.