Early failure of aortic valve conservation in aortic root aneurysm

Gallo, Ricardo; Kumar, Naresh; Halees, Zohair Al; Durán, Carlos M.G.

doi:10.1016/s0022-5223(95)70328-4

Cited by 31 publications

(14 citation statements)

References 7 publications

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“…Our findings correlate well with phase-contrast flow MRI studies which show systolic 3D velocity profiles exiting the aortic valve to be clover-shaped in healthy tricuspid aortic valve volunteers (18,19). This behavior of the valve leaflets might explain cases of early leaflet deterioration following re-implantation of the aortic valve within a tubular conduit without sinuses of Valsalva (2,20). Leaflet expansion beyond the commissural level would result in leaflet impact against the wall of the cylindrical conduit.…”

Section: Discussionsupporting

confidence: 85%

Aortic valve opening and closure: the clover dynamics

Lansac

Lim

et al. 2019

Ann. Cardiothorac. Surg.

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Background: Systolic aortic root expansion is reported to facilitate valve opening, but the precise dynamics remain unknown. A sonometric study with a high data sampling rate (200 to 800 Hz) was conducted in an acute ovine model to better understand the timing, mechanisms, and shape of aortic valve opening and closure. Methods: Eighteen piezoelectric crystals were implanted in 8 sheep at each annular base, commissures, sinus of Valsalva, sinotubular junction, nodulus of Arantius, and ascending aorta (AA). Geometric changes were time related to pressures and flows. Results: The aortic root was hemodynamically divided into left ventricular (LV) and aortic compartments situated, respectively, below and above the leaflets. During isovolumetric contraction (IVC), aortic root expansion started in the LV compartment, most likely due to volume redistribution in the LV outflow tract below the leaflets. This expansion initiated leaflet separation prior to ejection (2.1%±0.5% of total opening area). Aortic compartment expansion was delayed toward the end of IVC, likely related to volume redistribution above the leaflets due to accelerating aortic backflow toward the aortic valve and coronary flow reduction due to myocardial contraction. Maximum valve opening during the first third of ejection acquired a truncated cone shape [leaflet free edge area smaller than annular base area (−41.5%±5.5%)]. The distal orifice became clover shaped because the leaflet free edge area is larger than the commissural area by 16.3%±2.0%. Conclusions: Aortic valve opening is initiated prior to ejection related to delicate balance between LV, aortic root, and coronary dynamics. It is clover shaped at maximum opening in systole. A better understanding of these mechanisms should stimulate more physiological surgical approaches of valve repair and replacement.

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Section: Discussionsupporting

confidence: 85%

Aortic valve opening and closure: the clover dynamics

Lansac

Lim

et al. 2019

Ann. Cardiothorac. Surg.

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“…However, major pitfalls of this technique are the withdrawal of the sinuses of Valsalva and the inclusion of the interleaflet triangles within a graft tube, therefore impairing aortic annulus and cusp dynamics [4][5][6]. Inclusion of the aortic valve into a straight tube might compromise the durability of the repair and explain the reported cases of early valve deterioration [23]. To respect the dynamic anatomy of the aortic root, our group has favored the remodeling technique since 1997.…”

Section: Discussionmentioning

confidence: 99%

Aortic prosthetic ring annuloplasty: a useful adjunct to a standardized aortic valve-sparing procedure?☆

Lansac

Centa²,

Bonnet³

et al. 2006

European Journal of Cardio-Thoracic Surgery

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The addition of external aortic prosthetic ring annuloplasty improves the remodeling technique's operative reproducibility and short-term results. Therefore, its use as a systematical adjunct to the remodeling procedure is suggested. However, further long-term evaluation comparing this valve-sparing procedure to composite graft replacement should define the best surgical strategy for aortic root aneurysm.

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“…At that time, the cusp's free edge area exceeded the commissural area by +16.3 ± 2.0%. This behavior of the valve cusps might explain cases of early cusp deterioration following re-implantation of the aortic valve within a tubular conduit without sinuses of Valsalva (Gallo et al, 1995;Grande-Allen et al, 2000;Leyh et al, 1999) because cusp expansion beyond the commissural level would result in cusp impact against the wall of the cylindrical conduit. Furthermore, as previously published, aortic root expansion is also asymmetric, and it induces a tilting dynamic of the aortic valve throughout the cardiac cycle (Dagum et al, 1999;Lansac et al, 2005b).…”

Section: The Ascending Aorta: a Dynamic Structurementioning

confidence: 99%

“…Out of main series describing dystrophic aortic roots, aortic annular base diameter superior to 25 mm and sinotubular junction diameter superior to 35 mm are reported and should be considered as dilated (Gallo et al, 1995;Lansac & Di Centa, 2010c). .…”

Section: The Ascending Aorta: Descriptive Anatomymentioning

confidence: 99%