Variations in rotation of the aortic root and membranous septum with implications for transcatheter valve implantation

Tretter, Justin T.; Mori, Shigeo; Saremi, Farhood; Chikkabyrappa, Sathish; Thomas, Kristen; Bu, Fang; Loomba, Rohit S.; Alsaied, Tarek; Spicer, Diane E.; Anderson, Robert H.

doi:10.1136/heartjnl-2017-312390

Cited by 34 publications

(56 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Similarly to our previous findings (Tretter et al ), the mean height of the membranous septum, measured in the plane at right angles to the virtual basal ring, was 6.6 ± 2.0 mm. Its mean width, as assessed using the plane of the virtual basal ring, was 10.0 ± 4.2 mm, and was 10.2 ± 3.1 mm when using the central point of its height.…”

Section: Resultssupporting

confidence: 90%

“…We had previously revealed the significant individual variation in the size of the membranous septum (Tretter et al ), which was confirmed by the present study as well. Furthermore, the variation in the location of the membranous septum relative to the virtual basal ring was clarified in the present study.…”

Section: Discussionsupporting

confidence: 92%

“…At the stage of initial closure of the interventricular foramen, however, the aortic root is encased in a turret of outflow tract myocardium. It is only subsequent to regression of this myocardium collar, with concomitant formation of the aortic valvar sinuses, that it becomes possible to recognize the presence of the fibrous interleaflet triangles (Anderson et al ; Tretter et al ).…”

Section: Discussionmentioning

confidence: 99%

“…The detailed anatomy of the membranous septum, however, as well as its individual variations, has yet to be fully clarified. Based on our previous experiences (Massing and James, 1976;Anderson et al 2000;Saremi and Krishnan, 2007;Mori et al 2015aMori et al , 2016bTretter et al 2017), therefore, we have revisited the living anatomy of the membranous septum using computed tomographic angiography. Our study has revealed potentially important clinical correlations between its size and various measurements of the aortic root, including dilation, rotation, elongation, tilting, and wedging (Tretter et al 2017;Mori et al 2014Mori et al , 2017bSaremi et al 2017b).…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Relationship between the membranous septum and the virtual basal ring of the aortic root in candidates for transcatheter implantation of the aortic valve

et al. 2018

Self Cite

View full text Add to dashboard Cite

Knowledge of the anatomy of the membranous septum, as a surrogate to the location of the atrioventricular conduction axis, is a prerequisite for those undertaking transcatheter implantation of the aortic valve (TAVI). Equally important is its relationship of the virtual basal ring. This feature, however, has yet to be adequately described in the living heart. We analyzed computed tomographic angiographic datasets from 107 candidates (84.1 ± 5.2 years, 68% women) for TAVI. Using multiplanar reconstructions, we measured the height and width of the membranous septum, and the distances of its superior and inferior margins from the virtual basal ring plane. We also assessed the extent of wedging of the aortic root between the mitral valve and the ventricular septum. Mean heights and widths of the membranous septum were 6.6 ± 2.0, and 10.2 ± 3.1 mm, respectively, with its size significantly associated with that of the aortic root (P < 0.05). Its superior and inferior margins were 4.5 ± 2.3 and 2.1 ± 2.1 mm, respectively, from the plane of the basal ring. The inferior distance, the surrogate for the adjacency of the atrioventricular conduction axis, was ≤ 5mm in 91% of the patients. Deeper wedging of the aortic root was independently correlated with a shorter inferior distance (β = 0.0569, P = 0.0258). The membranous septum is appreciably closer to the virtual basal ring than previously appreciated. These findings impact on estimations of the risk of damage to the atrioventricular conduction axis during TAVI. Clin. Anat. 31:525-534, 2018. © 2018 Wiley Periodicals, Inc.

show abstract

Section: Resultssupporting

confidence: 90%

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Relationship between the membranous septum and the virtual basal ring of the aortic root in candidates for transcatheter implantation of the aortic valve

et al. 2018

Self Cite

View full text Add to dashboard Cite

show abstract

“…Although the aortic root is usually described as consisting of three equal leaflets, commissures, and sinuses of Valsalva (Zimmerman, 1969;Sutton 3rd et al, 1995), it is actually an asymmetrical structure with geometrically distinct individual sinuses and subtly variable intersinus dimensions (Vollebergh and Becker, 1977;Silver and Roberts, 1985;Choo et al, 1999;Berdajs et al, 2007;Tretter et al, 2018). The small degree of dimensional differences among the sinuses and the dynamic changes in the aortic root during the cardiac cycle have impeded precise quantification of its anatomy under physiological conditions.…”

Section: Introductionmentioning

confidence: 99%

Three‐Dimensional Computed Tomographic Analysis of Normal and Aneurysmal Aortic Roots: Is There a Specific Geometric Pattern in the Aortic Root?

Choo

et al. 2019

Clinical Anatomy

View full text Add to dashboard Cite

Current knowledge of the aortic root geometric anatomy and its surgical implications remain limited. We analyzed multiple predefined parameters of the aortic root to increase our understanding of the geometric changes that occur in normal and aneurysmal transformations. Between November 2003 and September 2015, the aortic roots of 107 healthy subjects (control group) and 105 annuloaortic ectasia (AAE) patients (AAE group) were analyzed using multiplanar reformatted computed tomographic images. The intercommissural distance (ICD), sinus width (SW), and sinus volume (SV) of the left (LCS), right (RCS), and noncoronary sinuses (NCS) of Valsalva were adopted as study parameters. In the control group, all study parameters of the LCS were smaller than those of the RCS and the NCS. In the AAE group, all parameters of the LCS were significantly smaller than those of the RCS or NCS, but the RCS and NCS parameters were similar. Proportionately less LCS enlargement relative to either the RCS or NCS was observed in root aneurysm(AAE group) than in the control group. We observed a distinct aortic root geometric pattern which was characterized by the LCS being smaller than either the RCS or NCS, while the latter were similar. This geometric configuration was significantly accentuated in AAE patients due to the greater disproportionate disparity in the LCS relative to either the RCS or NCS than in the roots of normal control subjects. Clin. Anat. 32:117–123, 2019. © 2019 Wiley Periodicals, Inc.

show abstract

What is the real cardiac anatomy?

et al. 2019

Self Cite

View full text Add to dashboard Cite

The heart is a remarkably complex organ. Teaching its details to medical students and clinical trainees can be very difficult. Despite the complexity, accurate recognition of these details is a pre‐requisite for the subsequent understanding of clinical cardiologists and cardiac surgeons. A recent publication promoted the benefits of virtual reconstructions in facilitating the initial understanding achieved by medical students. If such teaching is to achieve its greatest value, the datasets used to provide the virtual images should themselves be anatomically accurate. They should also take note of a basic rule of human anatomy, namely that components of all organs should be described as they are normally situated within the body. It is almost universal at present for textbooks of anatomy to illustrate the heart as if removed from the body and positioned on its apex, the so‐called Valentine situation. In the years prior to the emergence of interventional techniques to treat cardiac diseases, this approach was of limited significance. Nowadays, therapeutic interventions are commonplace worldwide. Advances in three‐dimensional imaging technology, furthermore, now mean that the separate components of the heart can readily be segmented, and then shown in attitudinally appropriate fashion. In this review, we demonstrate how such virtual dissection of computed tomographic datasets in attitudinally appropriate fashion reveals the true details of cardiac anatomy. The virtual approach to teaching the arrangement of the cardiac components has much to commend it. If it is to be used, nonetheless, the anatomical details on which the reconstructions are based must be accurate. Clin. Anat. 32:288–309, 2019. © 2019 The Authors. Clinical Anatomy published by Wiley Periodicals, Inc. on behalf of American Association of Clinical Anatomists.

show abstract

Variations in rotation of the aortic root and membranous septum with implications for transcatheter valve implantation

Abstract: The central fibrous body is wider, providing greater fibrous support, in the setting of clockwise rotation of the aortic root. Individuals with this pattern may be more vulnerable to conduction damage following TAVI. Knowledge of such variation may prove invaluable for risk stratification.

Cited by 34 publications

References 27 publications

Relationship between the membranous septum and the virtual basal ring of the aortic root in candidates for transcatheter implantation of the aortic valve

Relationship between the membranous septum and the virtual basal ring of the aortic root in candidates for transcatheter implantation of the aortic valve

Three‐Dimensional Computed Tomographic Analysis of Normal and Aneurysmal Aortic Roots: Is There a Specific Geometric Pattern in the Aortic Root?

What is the real cardiac anatomy?

Contact Info

Product

Resources

About