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Sinus Valsalva asymmetry is the “normal” aortic root anatomy

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12 diapositives · 622 Views · Aug 08, 2014

Sinus Valsalva asymmetry is the “normal” aortic root anatomy. Andras C. Kollar UTMB, Galveston TX. USA. Objective and methods. To obtain macroscopic tissue dimensions and geometry patterns of sinus wall segments in fresh autopsy specimens

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Sinus Valsalva asymmetry is the “normal” aortic root anatomy
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  1. Sinus Valsalva asymmetry is the “normal” aortic root anatomy Andras C. Kollar UTMB, Galveston TX. USA

  2. Objective and methods • To obtain macroscopic tissue dimensions and geometry patterns of sinus wall segments in fresh autopsy specimens • Unselected autopsies (>18 years of age) with no aortic valve/root pathology (n=30) • Valve competence was tested with water probe • The aortic root was dissected away from the heart • The coronary arteries were amputated

  3. Methods: the specimens were opened at the commissure between R and NC leaflets

  4. Methods: the valve leaflets were excised

  5. Methods: the sinus wall segments were separated from the scalloped annulus

  6. Methods: two radial incisions were made to flatten naturally bulging sinus wall segments

  7. Measurements: sinus length (L), width (W) and intercommissural distance (IC)(dashed line: sinus ridge arching between commissures)

  8. Results: average sinus dimensions

  9. Summary of Sinus Wall Dimensional Relationships STJ:BR Overall Spec # Age Ratio IC Width Length Sinus SA Pattern 1 53 1.05 L<R=NC L<R=NC R=NC<L R<NC<L Asymmetric 2 65 1.00 L<R=NC R<L=NC R<L=NC R<L<NC Asymmetric 3 47 0.96 L<R=NC L<R=NC L=R<NC L<R<NC Asymmetric 4 30 0.90 R=L<NC L<R=NC L=R=NC L<R=NC Asymmetric 5 67 1.09 L=R=NC L=R<NC L<R=NC L<R<NC Asymmetric 6 20 0.95 L<R<NC L<R<NC L=NC<R L<NC<R Asymmetric 7 44 0.89 L=R<NC L<R<NC L<R<NC L<R<NC Asymmetric 8 53 0.96 L<NC<R L<NC<R L=NC<R L<NC<R Asymmetric 9 68 1.05 L<R<NC L<R<NC L=R<NC L<R<NC Asymmetric 10 70 1.04 NC<L=R L=R=NC L<R<NC L<R<NC Asymmetric 11 50 0.92 R<L=NC L=R<NC L=R=NC R<L<NC Asymmetric 12 78 1.08 NC<L<R NC<L=R NC<L=R NC<R<L Asymmetric 13 48 1.08 L<R<NC L=R<NC R<L=NC R<L<NC Asymmetric 14 75 1.08 L<NC<R L<R=NC L<NC<R L<NC<R Asymmetric 15 58 1.00 L=NC<R L=NC<R L=NC<R L=NC<R Asymmetric 16 25 0.91 L=R=NC L=R=NC R<L=NC NC<L<R Asymmetric 17 62 1.04 L<R=NC L<NC<R L<R=NC L<NC<R Asymmetric 18 96 1.35 L=R=NC L=R=NC L<R<NC L<R<NC Asymmetric 19 44 1.00 L=R<NC L=R<NC L=R=NC L=R<NC Asymmetric 20 53 1.00 L<R<NC L<R=NC L<R=NC L<R<NC Asymmetric 21 55 1.10 NC<R=L NC<L=R NC=R<L NC<R<L Asymmetric 22 35 1.00 NC<R=L R=NC<L L=NC<R NC<L<R Asymmetric 23 59 1.19 L=NC<R L=R=NC L=R=NC L<R=NC Asymmetric 24 43 0.91 L=R<NC L=R<NC L=R<NC R<L<NC Asymmetric 25 37 0.91 L=R=NC L=R=NC L=R=NC L<R=NC Symmetric 26 36 0.95 L<R=NC L=NC<R L=R=NC L<NC<R Asymmetric 27 31 0.84 L<R=NC L=R=NC R<L=NC R<L<NC Asymmetric 28 84 1.17 L=NC<R L<NC<R L<R=NC L<NC<R Asymmetric 29 43 0.92 L=R=NC L<R=NC L=R=NC L<R<NC Asymmetric 30 41 0.95 L<R<NC L<R<NC L<R=NC L<R<NC Asymmetric

  10. (1 mm difference in direct size measurements was considered insignificant)

  11. Conclusions • The normal Valsalva sinuses are almost always asymmetric • Aneurysmal dilatation likely exaggerates the preexisting asymmetry • Based on these data a new graft design is proposed for aortic root remodeling

  12. “Cone” graft for aortic root remodeling • Widening provides excess material to recreate sinus bulges • The tongues are individually tailored to match asymmetry (US patent is pending – application # 12127639)