Sinus Valsalva asymmetry is the “normal” aortic root anatomy

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)