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Background. Aortic valve leaflets asymmetry has been known since Leonardo Da Vinci, but our aim was to evaluate their relationship between size and shape, not defined in children, which we hypothesized correlated with coronary arteries origin. Methods. Consecutive pediatric patients with trans-esophageal echocardiography (TEE), with or without trans-thoracic echocardiography (TTE), were included in our study. Exclusion criteria: a) bicuspid aortic valve, b) aortic valve stenosis, c) hypoplasia of aortic valve annulus, or aortic root; d) truncal valve, e) coronary artery atresia, f) previous surgery on aortic valve and/or coronary arteries. In pre-operative TTE and intra-operative TEE inter-commissural distance and length of aortic valve leaflets were measured in short axis view at the period of isovolumetric contraction in systole. Echocardiography investigations, anonymized and randomly coded, were independently reviewed by at least two readers. Echocardiography, angiography, cardiac CT scan and MRI, and operative notes were reviewed to identify origin of coronary arteries. Findings. 261 pediatric patients were identified, 93 excluded per our criteria, leaving 168 patients, age 2.6 ± 4.3 years, weight 12.87 ± 17.34 kg, 128 (76%) with normal and 40 (24%) with abnormal coronary arteries. In TTE and TEE measurements the non-coronary leaflet had larger area (P |
