Supra-aortic ridge?

[francie12]

A quick question for anatomy experts out there...Try as I might, googling every possible way, I can't find a definition or diagram that will tell me exactly what the supra-aortic ridge is. Apparantly, Matt's dilation extends beyond the supra-aortic ridge into an area where it can't be easily seen on an echo. We've just received a card notifyng that it's time to make an appointment for our first echo in a year, and I'm boning up in an effort to be prepared! Pediatric geneticist has ordered an MRA of the whole aorta to be done in the summer, but she has not been in touch with Matt's cardiologist. Guess it's up to me to explain things. I'll be handing him photocopies of the consultation report, but I want to thoroughly inderstand what's in it! Any help much appreciated. I've figured out sinuses of valsalva, aortc annulus and proximal ascending aorta, but supra-aortic ridge eludes me! (I'm trying to get a photo of Matt and me to put up here so you can see who we are.)

 

[PJmomrunner]

Hi Francie:

In my quick search for "supra-aortic ridge" I found many references to it, but, as you said, no real definition. The link below gives an explanation of the three types of aortic stenosis. In the explanation for subaortic stenosis they talk about the "ridge," while in the explanation of supra-aortic stenosis they refer to a similar structure as an "hourglass" or "waist." Do you think this could be the supra-aortic ridge?

http://www.mayoclinic.org/congenitalaorticstenosis-rst/types.html

 

[PJmomrunner]

This (from http://www.echoincontext.com/int1/skillI1_15.asp) implies that the supra-aortic ridge is the same as the sinotubular junction (the place where the aorta meets the sinuses of valsalva):

 

[francie12]

Thanks, PJ. The diagram is clear. Now if I'm right in thinking that the proximal ascending aorta comes right out of the supra-aortic ridge, and they do know the dimensions of that, I wonder why they say he has "dilatation beyond the supra-aortic ridge and he is dilated out into the distance beyond where the echocardiogram can visualize easily?" It must be that they are talking about closer to the arch? And I wonder why the echo can't see that when it can image the other structures so clearly? I'd like to know more about echocardiography in general!

 

[PJmomrunner]

Well, I surely don't know much about echocardiography, but I did watch both my children when they had their echos done. I know that in order to visualize their aortas a firm pillow was put under their backs to cause them to arch their backs in an exaggerated way so that their heads were way back (uncomfortably so). I talked to the echo tech about what she was doing and she said they do more views on a pediatric echo than they do on an adult one. For whatever reason, they did not see my aneurysm (which is largest at about the midpoint between the sinotubular junction and the innominate artery, but my entire ascending aorta is "diffusely ectatic," which means dialated to some extent) on the transthoracic (regular) echo; they first saw it on the TEE.

Something else I didn't know at first, but that became very obvious when I looked at my CT (on my own copy on a DVD), is that the aorta comes out of the heart and goes upward, then turns toward the spine and runs down along the inside of the spine (good plan for protection of the major artery).

BTW, I also have a 13 year old son. His valve is supposedly not BAV, but I haven't had the aortic specialist look at the echo tape and even my latest echo said my BAV appears to be TAV. It must have something to do with the orientation of the valve that it appears that way on echo, yet is definitively BAV by CT and TEE. I'd rather it was me than my son or daughter (who also has a supposed TAV).

 

[francie12]

Thanks so much for your input, PJ. Echo techs have never used pillows or positioned Matt in any way other than side and back...hmm...I guess they felt they found what they were looking for (?) I'm glad we have the backup of the MRA which will tell the full story, I hope.

So glad to hear that your son and daughter have three-leaved AVs! Like you, I would rather it was me. I'd go with the mechanical and call it a day! Reading these echos must be something of an art. When I had my own done (due to thousands of benign PVC's a day) the tech said my AV looked bicuspid from one angle (she called it "eccentric"), and tri from another. They finally ruled it normal and fully functioning, but I'm guessing there are all kinds of aortic valves!

Anyway, thanks again for your input. Sending quiet wishes from afar that your own heart situation develops in the best possible way.

 

[hpuehler]

Echo

Echo

My experience with the ECHOS is that on some in the past it was stated to be a tri-valve and on one from three years ago it states that it appeared that it could be a bicuspid valve but it also appeared that it was not. My TEE that I just had in December showed a tri-valve and the surgeon was going to try and fix the valve. When he got in there, he said all the ECHOs were wrong. I had a bicuspid valve that one half plus half of the other side where fused in an L shape and the other cusp was very thick with layers of tissue and it was just "flailing back and forth and was not working at all. My surgeon said that ECHOs do not prove to be very reliable to observe structure of the heart, but are good as a diagnostic tool to determine amount of leakage etc. He said he would never rely on an ECHO. He wants me to have a yearly CT scan to monitor the size of my aorta. He feels that to his trained eye it is dialated but not enough to show up on any ECHO or CT at this point. I guess I thought that ECHOs were more accurate than that. I guess I learned something new.

Heather