Proximal ascending aorta size is associated with the incidence of de novo aortic insufficiency with left ventricular assist device
Hidefumi NishidaT. SongD. OnsagerAnn NguyenJonathan GrinsteinBow ChungB. SmithSara KalantariNitasha SarswatGene KimSean PinneyValluvan JeevanandamTakeyoshi Ota
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The aortic root is a complex structure whose single components are of paramount importance in assuring proper functioning of the aortic valve. In fact, opening and closing behaviours of the aortic leaflets are regulated by the interaction of the various components of the aortic root as well as by the characteristics of blood flow. For many years, aortic root replacement has been considered as the standard option of surgical correction for aortic root aneurysm, regardless of the intrinsic and organic lesions of the valve cusps. The analysis of the normal anatomy and physiology of this peculiar structure is the basis for establishing the surgical transition, in selected cases, from aortic root replacement to aortic valve-sparing operation.
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Sinotubular junction dilation is one of the most frequent pathologies associated with aortic root incompetence. Hence, we create a finite element model considering the whole root geometry; then, starting from healthy valve models and referring to measures of pathological valves reported in the literature, we reproduce the pathology of the aortic root by imposing appropriate boundary conditions. After evaluating the virtual pathological process, we are able to correlate dimensions of non-functional valves with dimensions of competent valves. Such a relation could be helpful in recreating a competent aortic root and, in particular, it could provide useful information in advance in aortic valve sparing surgery.
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Aortic valve repair
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Background: The study was aimed at investigating the mathematical relationship between the aortic valve and aortic root through CTA imaging-based reconstruction. Methods: We selected 121 healthy participants and analyzed the measurements of aortic root dimensions, including the sinotubular junction (SJT), ventriculo-arterial junction (VAJ), maximum sinus diameter (SD), sinus height (SH), effective height (eH) and coaptation height (cH). We also reconstructed 3-D aortic valve cusps using CTA imaging to calculate the aortic cusp surface areas. Data were collected to analyze the ratios and the correlation between aortic valve and aortic root dimensions. Results: Among healthy participants, the STJ was approximately 10% larger than the VAJ, and the SD was 1.375 times larger than the VAJ. The average eH and cH were 8.94 mm and 3.62 mm, respectively. The aortic cusp surface areas were larger in men than women. Regardless of sex, the non-coronary cusp was found to be largest, and was followed by the right coronary cusp and the left coronary cusp. Although the aortic root dimensions were also significantly larger in in men than women, the STJ to VAJ, SD to VAJ, and SH to VAJ ratios did not significantly differ by sex. The mathematical relationship between the aortic cusp surface areas and VAJ orifice area was calculated as aortic cusp surface areas Conclusions: The aortic root has specific geometric ratios. The mathematical relationship between the aortic valve and aortic root might be used to guide aortic valve repair.
Aortic sinus
Aortic valve repair
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Pseudoaneurysm
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Background and aim of the study The relationship between aortic valve pathology and the aortic root and ascending aortic dimensions in cardiac surgery patients is unclear, and its clarification was the objective of this study. Methods The severity of valve pathology, whether aortic valve stenosis (AS) or aortic valve regurgitation (AR), and the aortic dimensions (aortic root and ascending aorta) were prospectively evaluated with echocardiography in 500 consecutive patients with tricuspid aortic valve (TAV) or bicuspid aortic valve (BAV) who had undergone surgery due to aortic valve and/or ascending aortic disease. Results The distribution of valve pathology was similar in TAV and BAV patients when the aorta was non-dilated. However, when the aorta was dilated, AS was seen predominantly in BAV patients (n = 76) compared to TAV patients (n = 2). In TAV and BAV patients with non-dilated aortas, an increased severity of valve pathology was associated with smaller dimensions of the aortic root and the ascending aorta. In TAV and BAV patients with dilated aortas, an increase in the severity of AR was associated with a decreasing dimension of the ascending aorta but an increasing dimension of the aortic root. In BAV patients with aneurysm, the severity of AS was associated with a decreased dimension of the aortic root and the ascending aorta. Conclusion Patients with AS and ascending aortic dilatation almost exclusively have a BAV. An increasing severity of valve pathology was related to decreasing dimensions of the aortic root and the ascending aorta, and the pattern was strikingly similar in TAV and BAV patients. The high frequency of ascending aortic dilatations in BAV patients cannot be explained by the valve pathology.
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