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Published byBrittney Jones Modified over 9 years ago
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Sinus Valsalva asymmetry is the “normal” aortic root anatomy
Andras C. Kollar UTMB, Galveston TX. USA
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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
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Methods: the specimens were opened at the commissure between R and NC leaflets
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Methods: the valve leaflets were excised
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Methods: the sinus wall segments were separated from the scalloped annulus
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Methods: two radial incisions were made to flatten naturally bulging sinus wall segments
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Measurements: sinus length (L), width (W) and intercommissural distance (IC) (dashed line: sinus ridge arching between commissures)
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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
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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
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(1 mm difference in direct size measurements was considered insignificant)
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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
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“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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