Haemodynamic Effect of Supraaortic Ridge Enhancement on the Closure Mechanism of the Aortic Valve and its Implications in Aortic Valve Repair

Abstract

The presence of the sinus of valsalva plays an essential part in the closing mechanism of the aortic valve. High-energy vortices are initiated at the upper limit of each sinus or supraaortic crest, and last during the whole valve closing time. An attempt was made to prove this hypothesis in vivo by intermittent augmentation of each supraaortic ridge. In a series of five dogs without cardiopulmonary bypass, pledgeted sutures were placed at the level of each crest and passed through tourniquets. In a series of three sheep, similar sutures were placed under direct vision with cardiopulmonary bypass. The supraaortic crests were augmented or maintained normal by tightening or loosening the tourniquets repeatedly. Simultaneous aortic and ventricular pressures and 2D- and M-mode echocardiography were recorded. In the dog series the results were unpredictable due to variability in the supraaortic crest enhancement because the sutures did not correspond to the anatomical crest. In the sheep series the sutures were correctly placed and M-mode echocardiography demonstrated a significant (p less than 0.01) shortening in systolic time. These results suggest the use of enhancement of the supraaortic crest as an adjunct technique in aortic valve repair.

Regional analysis of dynamic deformation characteristics of native aortic valve leaflets

“…Previoius authors have suggested that the presence of the sinuses of Valsalva are to assist in cushioning early diastolic transvalvular pressures (Beck et al, 2001; Duran et al, 1990; Sacks et al, 2009). Simulations have shown that the absence of the sinuses results in additional stresses on the leaflets , as does a reduction in the sinus wall compliance (Beck et al, 2001).…”