Opening and Closing Characteristics of the Aortic Valve After Different Types of Valve-Preserving Surgery

Leyh, Rainer; Schmidtke, Claudia; Sievers, Hans‐Hinrich; Yacoub, Magdi H.

doi:10.1161/01.cir.100.21.2153

Cited by 293 publications

(197 citation statements)

References 20 publications

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“…Although vortices cannot be visualized in the sinuses of Valsalva 20) and valve opening and closing dynamics are abnormally high in postoperative patients with negligible sinuses, near-normal valve opening and closing characteristics can be achieved by creating a sinus bulge. 21,22) Finite element analyses have demonstrated similar findings. 23,24) Many devices can create pseudosinuses.…”

Section: Various Vsrr Techniquesmentioning

confidence: 55%

Valve-sparing Aortic Root Replacement

Shimizu

Yozu

2011

Ann Thorac Cardiovasc Surg

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The aortic root has a unique 3-dimensional configuration and the distinctive function of supporting the aortic valve and blood vessels. The sinuses of Valsalva are crucial to create appropriate eddy currents that are important in initiating and coordinating aortic valve closure and promoting coronary artery blood flow. Most aneurysms in the aortic root are associated with degenerative changes in the elastic media rather than atherosclerosis. Valvesparing root repair has become widely accepted, although the Bentall procedure remains the gold standard. Because reimplantation using the Valsalva graft allows root geometry to be retained and theoretically and practically prevents recurrent aortic valve regurgitation, it is considered the most reliable and preferred technique among various valve-sparing aortic root repair procedures. Ann Thorac Cardiovasc Surg 2011; 17: 330-336 doi: 10.5761/atcs.ra.11.01675 Anatomy of the Aortic RootThe aortic root is the most proximal part of the aorta. It has a unique 3-dimensional (3D) configuration with a clover-like dilation of the sinuses of Valsalva within which the aortic valve forms a three-pronged crown. The attachment of each valve leaflet to the aortic wall is semilunar, running from the basal attachment within the left ventricle to the distal attachment at the sinotubular (ST) junction. The virtual circle connecting the lowest point on each semilunar attachment is called the basal ring. The posterior half of the basal ring (including the base of the non-coronary sinus) is fibrous, and the anterior half (including the base of the left and right coronary sinuses) is muscular. The fibrous portion is considered weaker and easy to dilate. The semilunar attachment forms a hemodynamic (but not an anatomical) junction between the left ventricle and the aorta. The anatomical ventriculo-aortic junction is the circle lying a little above the basal ring (Fig. 1).1) The bundle of His lies immediately below the membranous ventricular septum that lies immediately beneath the commissure between the right and noncoronary cusps (Fig. 2).2-4) The diameter of the aorta at the ST junction is 81% of the diameter at the aortic sinuses, and 97% at the basal ring. 5) Function of Aortic RootThe aortic root not only channels blood but also supports the aortic valve leaflets. The clover-like dilation of sinuses of Valsalva is crucial to create appropriate eddy currents in the supravalvular region, which are important for initiating and coordinating aortic valve closure and promoting coronary artery blood flow. Etiology and Pathology of the Aortic RootMost aneurysms in the aortic root are associated with degenerative changes in the elastic media, although atherosclerosis is the major etiology of aneurysms in other regions of the aorta. This probably correlates with the higher concentration of elastic fibers in the media of the aortic root. Cystic medial degeneration, or elastic fiber fragmentation and smooth muscle loss, are typical of the histological characteristics of root aneurysms. Aortic root...

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Section: Various Vsrr Techniquesmentioning

confidence: 55%

Valve-sparing Aortic Root Replacement

Shimizu

Yozu

2011

Ann Thorac Cardiovasc Surg

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“…Previous echocardiographic study showed that the presence of sinuses of Valsalva is important for normal cusp motion and reduction of cusp stress. 33 Similarly, CMR using time-resolved 3-dimensional phase contrast imaging showed that using an anatomically correct Dacron graft with three aortic sinuses generated flow vortices similar to normal volunteers. 34 However, patients with a repairable BAV and a dilated aortic annulus (≥28 mm diameter) often do not do well with a simple subcommissural annuloplasty.…”

Section: Thoracic Aortic Aneurysm Repairmentioning

confidence: 94%

Bicuspid Aortic Valve Disease: New Insights

Wang

Delgado

et al. 2017

Structural Heart

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Bicuspid aortic valve (BAV) is the most common cardiac congenital abnormality and can be associated with significant valvulopathy or aortopathy. Current active areas of BAV research include prediction of development of valve dysfunction and aortopathy, and the various surgical valvular strategies with or without ascending aortic replacement. There is also increasing interest in the emerging role of transcatheter aortic valve replacement (TAVR) even though it is listed as a relative contraindication in current TAVR recommendations. Although there are clearly established guidelines in the clinical management and surgical techniques for the management of BAV with or without aortopathy, many of these newer surgical techniques have shown excellent post-surgical results but need to be directly compared against "standard" guidelines recommended treatment. As such, this creates new controversies regarding the clinical and surgical management of BAV. In this review, we have summarized the current understanding of the pathophysiology of BAV valvulopathy and aortopathy, various newer surgical therapies, and gaps in our scientific knowledge that require further research.

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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%