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 # )