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Sinus Valsalva asymmetry is the “normal” aortic root anatomy

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Presentation on theme: "Sinus Valsalva asymmetry is the “normal” aortic root anatomy"— Presentation transcript:

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
Left Sinus (n=30) Right Sinus Noncoronary Sinus Intercomissural distance (mm) 21.7±3.7 23.5±4.0 23.4±3.5 Sinus width (mm) 22.7±3.5 24.2±4.0 24.4±3.9 Sinus length (mm) 20.0±3.0 21.2±3.9 21.4±4.1 Sinus surface area (calculated mm2) 362.2±102.4 413.4±137.6 420±146.7 Length/width (ratio) 0.89±0.10 0.88±0.09 0.87±0.10

9 Summary of Sinus Wall Dimensional Relationships
STJ:BR Overall Spec # Age Ratio IC Width Length Sinus SA Pattern L<R=NC L<R=NC R=NC<L R<NC<L Asymmetric L<R=NC R<L=NC R<L=NC R<L<NC Asymmetric L<R=NC L<R=NC L=R<NC L<R<NC Asymmetric R=L<NC L<R=NC L=R=NC L<R=NC Asymmetric L=R=NC L=R<NC L<R=NC L<R<NC Asymmetric L<R<NC L<R<NC L=NC<R L<NC<R Asymmetric L=R<NC L<R<NC L<R<NC L<R<NC Asymmetric L<NC<R L<NC<R L=NC<R L<NC<R Asymmetric L<R<NC L<R<NC L=R<NC L<R<NC Asymmetric NC<L=R L=R=NC L<R<NC L<R<NC Asymmetric R<L=NC L=R<NC L=R=NC R<L<NC Asymmetric NC<L<R NC<L=R NC<L=R NC<R<L Asymmetric L<R<NC L=R<NC R<L=NC R<L<NC Asymmetric L<NC<R L<R=NC L<NC<R L<NC<R Asymmetric L=NC<R L=NC<R L=NC<R L=NC<R Asymmetric L=R=NC L=R=NC R<L=NC NC<L<R Asymmetric L<R=NC L<NC<R L<R=NC L<NC<R Asymmetric L=R=NC L=R=NC L<R<NC L<R<NC Asymmetric L=R<NC L=R<NC L=R=NC L=R<NC Asymmetric L<R<NC L<R=NC L<R=NC L<R<NC Asymmetric NC<R=L NC<L=R NC=R<L NC<R<L Asymmetric NC<R=L R=NC<L L=NC<R NC<L<R Asymmetric L=NC<R L=R=NC L=R=NC L<R=NC Asymmetric L=R<NC L=R<NC L=R<NC R<L<NC Asymmetric L=R=NC L=R=NC L=R=NC L<R=NC Symmetric L<R=NC L=NC<R L=R=NC L<NC<R Asymmetric L<R=NC L=R=NC R<L=NC R<L<NC Asymmetric L=NC<R L<NC<R L<R=NC L<NC<R Asymmetric L=R=NC L<R=NC L=R=NC L<R<NC Asymmetric 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 # )


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