A New Look at Structural Changes in the Aortic Root in Aortic Valve Stenosis

Abstract

The aim of the study was to identify new anatomical landmarks of the aortic root and the relationship between the sizes of anatomical structures using the method of computed tomography angiography to improve models of heart valves and the methods for their selection in clinical practice. Materials and Methods The dataset of computed tomography angiography prior to aortic valve replacement in 262 patients was analyzed. The mean age was 75.0±5.9 years. 99 (37.8±3.0%) men and 163 (62.2±3.0%) women took part in the study. The annulus fibrosus, sinotubular junction, and height of the sinuses of Valsalva were measured. Results In the tricuspid aortic valve group (n=251), in more than 50% of the cases, the diameter of the annulus fibrosus ranged from 23 to 26 mm. No significant association between the diameter of the annulus fibrosus and patient height (r=0.35; p=0.01) or body surface area (r=0.25; p=0.01) and the height of the sinuses of Valsalva (r=0.34; p=0.01) were revealed. Based on the ratio of the height of the sinuses of Valsalva and the diameter of the annulus fibrosus, three variants of the structure of the aortic root were identified: type A — K >1.05; type B— 0.95≤ K ≤1.05; type C— K <0.95. Type C of the aortic root was found to predominate in most cases, namely, in 98.0±0.9% (n=246). In the bicuspid aortic valve group (n=11), 2 patients had a type A of the aortic root, 1 patient had a type B, and 8 patients had a type C. Conclusion A classification of variants of the aortic root structure has been proposed, which will be useful not only for practitioners when choosing a treatment method, but also for researchers to understand the structural characteristics of the aortic root in patients with its pathology.

A Pig as a Model to Test Cardiovascular Devices

“…Moreover, type "A" was found mainly in pigs weighing 71-90 kg, and type "C" in animals weighing 40-60 and more than 90 kg. In a human the aortic type C root can be found in 98% of cases, type B -in 1.6% of cases, type A almost never occurs (0.4%) (Kobelev E. et al, [21]), Figure 9. Special attention could be paid to one or another type of root in an experimental animal when developing new models of transcatheter aortic valves for humans.…”

“…The type of aortic root was determined according to the procedure which was proposed in 2022 in order to determine the type of aortic root in humans [21]. The aortic root was thought to be a part of the ascending aorta from the fibrous ring of the aortic artery to the plane of the sinotubular junction.…”

Pigs as Models to Test Cardiovascular Devices

“…Moreover, type "A" was found mainly in pigs weighing 71-90 kg, and type "C" in animals weighing 40-60 and more than 90 kg. In a human, the aortic type C root can be found in 98% of cases, and type B in 1.6% of cases; type A almost never occurs (0.4%) (Kobelev E. et al, [21]) (Figure 10). Special attention should be given to certain types of aortic root in experimental animals when designing new models of transcatheter aortic valves for humans.…”

“…Moreover, type “A” was found mainly in pigs weighing 71–90 kg, and type “C” in animals weighing 40–60 and more than 90 kg. In a human, the aortic type C root can be found in 98% of cases, and type B in 1.6% of cases; type A almost never occurs (0.4%) (Kobelev E. et al [ 21 ]) ( Figure 10 ).…”

“…The type of aortic root was determined based on the procedure that was proposed in 2022 for determining the type of aortic root in humans [ 21 ]. The aortic root was thought to be a part of the ascending aorta from the fibrous ring of the aortic artery to the plane of the sinotubular junction.…”