sinus valsalva asymmetry is the “normal” aortic root anatomy andras c. kollar utmb, galveston...
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Sinus Valsalva Sinus Valsalva asymmetry is the asymmetry is the “normal” aortic “normal” aortic root anatomyroot anatomy
Andras C. KollarAndras C. Kollar
UTMB, Galveston TX. USAUTMB, Galveston TX. USA
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Objective and methodsObjective and methods
• To obtain macroscopic tissue dimensions To obtain macroscopic tissue dimensions and geometry patterns of sinus wall and geometry patterns of sinus wall segments in fresh autopsy specimenssegments in fresh autopsy specimens
• Unselected autopsies (>18 years of age) Unselected autopsies (>18 years of age) with no aortic valve/root pathology (n=30)with no aortic valve/root pathology (n=30)
• Valve competence was tested with water Valve competence was tested with water probeprobe
• The aortic root was dissected away from The aortic root was dissected away from the heartthe heart
• The coronary arteries were amputatedThe coronary arteries were amputated
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Methods: the specimens were Methods: the specimens were opened at the commissure opened at the commissure between R and NC leafletsbetween R and NC leaflets
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Methods: the valve leaflets Methods: the valve leaflets were excisedwere excised
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Methods: the sinus wall Methods: the sinus wall segments were separated from segments were separated from
the scalloped annulusthe scalloped annulus
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Methods: two radial incisions were Methods: two radial incisions were made to flatten naturally bulging made to flatten naturally bulging
sinus wall segmentssinus wall segments
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Measurements: sinus length Measurements: sinus length (L), width (W) and (L), width (W) and
intercommissural distance (IC)intercommissural distance (IC)(dashed line: sinus ridge arching between (dashed line: sinus ridge arching between
commissures)commissures)
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Results: average sinus Results: average sinus dimensionsdimensions
Left Sinus(n=30)
Right Sinus(n=30)
Noncoronary Sinus(n=30)
Intercomissuraldistance (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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STJ:BRSTJ:BR Overall OverallSpec # Spec # Age Age RatioRatio ICIC WidthWidth LengthLength Sinus SASinus SA PatternPattern
11 5353 1.051.05 L<R=NCL<R=NC L<R=NCL<R=NC R=NC<LR=NC<L R<NC<LR<NC<L AsymmetricAsymmetric22 6565 1.001.00 L<R=NCL<R=NC R<L=NCR<L=NC R<L=NCR<L=NC R<L<NCR<L<NC AsymmetricAsymmetric33 4747 0.960.96 L<R=NCL<R=NC L<R=NCL<R=NC L=R<NCL=R<NC L<R<NCL<R<NC AsymmetricAsymmetric44 3030 0.900.90 R=L<NCR=L<NC L<R=NCL<R=NC L=R=NCL=R=NC L<R=NCL<R=NC AsymmetricAsymmetric55 6767 1.091.09 L=R=NCL=R=NC L=R<NCL=R<NC L<R=NCL<R=NC L<R<NCL<R<NC AsymmetricAsymmetric66 2020 0.950.95 L<R<NCL<R<NC L<R<NCL<R<NC L=NC<RL=NC<R L<NC<RL<NC<R AsymmetricAsymmetric77 4444 0.890.89 L=R<NCL=R<NC L<R<NCL<R<NC L<R<NCL<R<NC L<R<NCL<R<NC AsymmetricAsymmetric88 5353 0.960.96 L<NC<RL<NC<R L<NC<RL<NC<R L=NC<RL=NC<R L<NC<RL<NC<R AsymmetricAsymmetric99 6868 1.051.05 L<R<NCL<R<NC L<R<NCL<R<NC L=R<NCL=R<NC L<R<NCL<R<NC AsymmetricAsymmetric1010 7070 1.041.04 NC<L=RNC<L=R L=R=NCL=R=NC L<R<NCL<R<NC L<R<NCL<R<NC AsymmetricAsymmetric1111 5050 0.920.92 R<L=NCR<L=NC L=R<NCL=R<NC L=R=NCL=R=NC R<L<NCR<L<NC AsymmetricAsymmetric1212 7878 1.081.08 NC<L<RNC<L<R NC<L=RNC<L=R NC<L=RNC<L=R NC<R<LNC<R<L AsymmetricAsymmetric1313 4848 1.081.08 L<R<NCL<R<NC L=R<NCL=R<NC R<L=NCR<L=NC R<L<NCR<L<NC AsymmetricAsymmetric1414 7575 1.081.08 L<NC<RL<NC<R L<R=NCL<R=NC L<NC<RL<NC<R L<NC<RL<NC<R AsymmetricAsymmetric1515 5858 1.001.00 L=NC<RL=NC<R L=NC<RL=NC<R L=NC<RL=NC<R L=NC<RL=NC<R AsymmetricAsymmetric1616 2525 0.910.91 L=R=NCL=R=NC L=R=NCL=R=NC R<L=NCR<L=NC NC<L<RNC<L<R AsymmetricAsymmetric1717 6262 1.041.04 L<R=NCL<R=NC L<NC<RL<NC<R L<R=NCL<R=NC L<NC<RL<NC<R Asymmetric Asymmetric 1818 9696 1.351.35 L=R=NCL=R=NC L=R=NCL=R=NC L<R<NCL<R<NC L<R<NCL<R<NC AsymmetricAsymmetric1919 4444 1.001.00 L=R<NCL=R<NC L=R<NCL=R<NC L=R=NCL=R=NC L=R<NCL=R<NC AsymmetricAsymmetric2020 5353 1.001.00 L<R<NCL<R<NC L<R=NCL<R=NC L<R=NCL<R=NC L<R<NCL<R<NC AsymmetricAsymmetric2121 5555 1.101.10 NC<R=LNC<R=L NC<L=RNC<L=R NC=R<LNC=R<L NC<R<LNC<R<L AsymmetricAsymmetric2222 3535 1.001.00 NC<R=LNC<R=L R=NC<LR=NC<L L=NC<RL=NC<R NC<L<RNC<L<R AsymmetricAsymmetric2323 5959 1.191.19 L=NC<RL=NC<R L=R=NCL=R=NC L=R=NCL=R=NC L<R=NCL<R=NC AsymmetricAsymmetric2424 4343 0.910.91 L=R<NCL=R<NC L=R<NCL=R<NC L=R<NCL=R<NC R<L<NCR<L<NC AsymmetricAsymmetric2525 3737 0.910.91 L=R=NCL=R=NC L=R=NCL=R=NC L=R=NCL=R=NC L<R=NCL<R=NC SymmetricSymmetric2626 3636 0.950.95 L<R=NCL<R=NC L=NC<RL=NC<R L=R=NCL=R=NC L<NC<RL<NC<R AsymmetricAsymmetric2727 3131 0.840.84 L<R=NCL<R=NC L=R=NCL=R=NC R<L=NCR<L=NC R<L<NCR<L<NC AsymmetricAsymmetric2828 8484 1.171.17 L=NC<RL=NC<R L<NC<RL<NC<R L<R=NCL<R=NC L<NC<RL<NC<R AsymmetricAsymmetric2929 4343 0.920.92 L=R=NCL=R=NC L<R=NCL<R=NC L=R=NCL=R=NC L<R<NCL<R<NC AsymmetricAsymmetric3030 4141 0.950.95 L<R<NCL<R<NC L<R<NCL<R<NC L<R=NCL<R=NC L<R<NCL<R<NC AsymmetricAsymmetric
Summary of Sinus Wall Dimensional Relationships
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(1 mm difference in direct size (1 mm difference in direct size measurements was considered insignificant)measurements was considered insignificant)
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ConclusionsConclusions
• The normal Valsalva sinuses The normal Valsalva sinuses are almost always asymmetricare almost always asymmetric
• Aneurysmal dilatation likely Aneurysmal dilatation likely exaggerates the preexisting exaggerates the preexisting asymmetryasymmetry
• Based on these data a newBased on these data a new
graft design is proposed graft design is proposed
for aortic root remodelingfor aortic root remodeling
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““Cone” graft for aortic root Cone” graft for aortic root remodelingremodeling
• Widening provides excess material to recreate sinus bulges
• The tongues are individually tailored to match asymmetry
(US patent is pending – application # 12127639)