scholarly journals Relationship Between Leaflets and Root in Normal Aortic Valve Based on Computed Tomography Imaging: Implication for Aortic Valve Repair

2021 ◽  
Vol 8 ◽  
Author(s):  
Tianyang Yang ◽  
Haini Wen ◽  
Ismail El-Hamamsy ◽  
Qiming Ni ◽  
Yanbin Sun ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Aortic Valve ◽  
Aortic Root ◽  
Three Dimensional ◽  
Aortic Valve Repair ◽  
Valve Repair ◽  
Effective Height ◽  
The Mean ◽  
The Relationship ◽  
Annulus Diameter

Objective: By assessing the normal dimensions and the relationship between the aortic root and leaflets in Chinese population, the objective of this three-dimensional computed tomography (3DCT)-based study was to establish a matching reference for leaflets and aortic root for aortic valve (AV) repair.Method: Electrocardiogram-gated multi-detector CT was performed on 168 Chinese participants with a normal aortic valve. Measurements of the aortic annuli and leaflets were obtained. The correlations between and the ratios of the specific root and leaflet measurements were analyzed. The references for the leaflet and root dimensions were suggested based on geometric height (gH) using a linear regression equation. The utility of the ratios was tested with CT images of 15 patients who underwent aortic valve repair.Result: The mean annulus diameter (AD), sino-tubular junction (STJ) diameter, geometric height (gH), effective height (eH), free margin length (FML), commissural height (ComH), inter-commissural distance (ICD), and coaptation height (CH) were 22.4 ± 1.7 mm, 27.3 ± 2, 0.4 mm, 15.5 ± 1.7 mm, 8.9 ± 1.2 mm, 32.0 ± 3.4 mm, 17.9 ± 1.9 mm, 23.1 ± 2.3 mm, and 3.1 ± 0.6 mm, respectively. The gH/AD, FML/ICD, and eH/ComH ratios were 0.69 ± 0.07, 1.38 ± 0.08, and 0.50 ± 0.07, respectively. The gH correlated with all other leaflet and root measurements (P < 0.01), whereas the FML demonstrated a better correlation with ICD compared with gH (R2 = 0.75, and R2 = 0.37, respectively). The FML/ICD and eH/ComH ratios might be used to assess leaflet-root mismatch and post-repair leaflet billowing.Conclusion: The normal aortic valve measurements based on 3DCT revealed a specific relationship between the root and leaflets; and this will guide the development of an objective method of aortic valve repair.

scholarly journals Aortic root numeric model: Annulus diameter prediction of effective height and coaptation in post–aortic valve repair

2013 ◽  
Vol 145 (2) ◽  
pp. 406-411.e1 ◽  
Author(s):  
Gil Marom ◽  
Rami Haj-Ali ◽  
Moshe Rosenfeld ◽  
Hans Joachim Schäfers ◽  
Ehud Raanani
Keyword(s):  
Aortic Valve ◽  
Aortic Root ◽  
Aortic Valve Repair ◽  
Valve Repair ◽  
Effective Height ◽  
Numeric Model ◽  
Annulus Diameter

Design Characteristics of a Three-Dimensional Geometric Aortic Valve Annuloplasty Ring

2013 ◽  
Vol 8 (5) ◽  
pp. 364-370 ◽  
Author(s):  
Philip S. Crooke ◽  
L. Alan Beavan ◽  
Charles D. Griffin ◽  
Domenico Mazzitelli ◽  
J. Scott Rankin
Keyword(s):  
Aortic Valve ◽  
Aortic Root ◽  
Three Dimensional ◽  
Diameter Ratio ◽  
Aortic Valve Repair ◽  
Least Squares Regression ◽  
Valve Repair ◽  
Annuloplasty Ring ◽  
Computed Tomographic ◽  
Root Area

Objective A full geometric annuloplasty ring could facilitate aortic valve repair. The purpose of this report was to document the design of such a ring using mathematical analyses of normal human aortic valve computed tomographic angiograms. Methods One-millimeter axial slices of high-resolution computed tomographic angiograms from 11 normal aortic roots were used to generate high-density x, y, and z coordinates of valve structures in Mathematica. Three-dimensional least squares regression analyses of leaflet-sinus coordinates were used to assess geometry of aortic valve and root structures. Results Normal valve geometry could be represented as three leaflet-sinus general ellipsoids nested within an elliptical aortic root. Minor-major diameter ratio of the valve base was 0.60 ± 0.07, and elliptical geometry extended vertically up the commissures. By contrast, leaflet-sinus horizontal circumferences were fairly circular (diameter ratios, 0.82–0.87), and the left coronary/noncoronary commissural post was located at the posterior base minor diameter-circumference junction, with the center of the right coronary leaflet opposite. Post location on the circumference was symmetrical, with a deviation of only ±2% to ±3% from 33.3% symmetry. Commissural posts flared outward by 5 to 10 degrees, and leaflet areas were statistically equivalent ( P > 0.10). From end diastole to midsystole, the aortic root became less elliptical (diameter ratio increased by 0.15), but root area expanded minimally (less than +5%). A one-piece rigid annuloplasty ring was designed with 2:3 base ellipticality, three 10-degree outwardly flaring symmetrical posts, and post height = base circumference/2π. Conclusions A three-dimensional aortic annuloplasty ring was designed that could prove useful for enhancing applicability and stability of aortic valve repair.

scholarly journals Comparison of bicuspid and tricuspid aortic valve repair

2020 ◽  
Author(s):  
Radosław Gocoł ◽  
Jarosław Bis ◽  
Marcin Malinowski ◽  
Joanna Ciosek ◽  
Damian Hudziak ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Hazard Ratio ◽  
Aortic Valve Repair ◽  
Pericardial Patch ◽  
Valve Regurgitation ◽  
Aortic Valve Regurgitation ◽  
Valve Repair ◽  
Tricuspid Aortic Valve ◽  
Valve Annulus ◽  
Annulus Diameter

Abstract   OBJECTIVES The aim of this study was to compare the outcomes of tricuspid aortic valve (TAV) and bicuspid aortic valve (BAV) repair. METHODS We assessed mortality, freedom from reoperation and the rate of aortic valve regurgitation recurrence. Mortality in both groups was compared with expected survival, and risk factors for reoperation were identified. RESULTS From January 2010 to April 2020, a total of 368 elective aortic valve repair procedures were performed, including 223 (60.6%) in patients with TAV. The perioperative mortality was 0.7% in the BAV group and 3.6% in the TAV group (P = 0.079). Estimated survival at 5 years in the BAV versus TAV group was 97 ± 3% vs 80 ± 6%, respectively (P < 0.001). Freedom from reoperation at 5 years in the TAV versus BAV group was 96 ± 3% vs 93 ± 4%, respectively (P = 0.28). Grade 2 or more aortic valve regurgitation was noted in 9.9% of BAV patients and 11% of TAV patients (P = 0.66). Reoperation was predicted by cusp perforation [hazard ratio 15.86 (4.44–56.61); P < 0.001], the use of pericardial patch [hazard ratio 8.58 (1.96–37.53); P = 0.004] and aortic valve annulus diameter >27.5 mm [hazard ratio 3.07 (0.99–9.58); P = 0.053]. CONCLUSIONS BAV repair is as durable as TAV repair. BAV is not a predictor of a higher rate of reoperations. BAV repair yields survival comparable to expected. Cusp perforation, aortic valve annulus diameter >27.5 mm and the use of pericardial patch adversely impact long-term outcome of aortic valve repair.

scholarly journals An expansible aortic ring to preserve aortic root dynamics after aortic valve repair†

2014 ◽  
Vol 47 (3) ◽  
pp. 482-490 ◽  
Author(s):  
Mijiti Wuliya ◽  
Ghassan Sleilaty ◽  
Isabelle Di Centa ◽  
Nizar Khelil ◽  
Alain Berrebi ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Root ◽  
Aortic Ring ◽  
Aortic Valve Repair ◽  
Valve Repair ◽  
Root Dynamics

Predictors of Aortic Valve Repair Failure

2019 ◽  
Vol 14 (3) ◽  
pp. 199-208 ◽  
Author(s):  
Bobby Yanagawa ◽  
Amine Mazine ◽  
Ismail El-Hamamsy
Keyword(s):  
Aortic Valve ◽  
Three Dimensional ◽  
Major Complication ◽  
Aortic Insufficiency ◽  
Aortic Valve Repair ◽  
Valve Repair ◽  
Current State ◽  
Annular Dilation

Aortic valve repair is the preferred approach for the treatment of severe aortic insufficiency (AI), as it allows patients to keep their native aortic valve, thus substantially reducing the risk of prosthesis-related complications. Several studies have documented excellent long-term outcomes of aortic valve repair. The major complication of this operation is AI recurrence, with ensuingneed for reoperation. The surgical experience accumulated over the last two decades has allowed for better understanding of the mechanisms of recurrent AI after aortic valve repair. Herein, we review the current state of knowledge on predictors of aortic valve repair failure. These include unaddressed annular dilation, residual cusp prolapse or retraction, commissural orientation, and use of patch material. This enhanced understanding has led to the development of increasingly refined techniques and improved patient outcomes. Continued follow-up and detailed data collection at the time of surgery, together with three-dimensional echo imaging, will allow further improvements in aortic valve repair.

Cusp-based geometric height-oriented repair of a pediatric aortic valve

2020 ◽  
Keyword(s):  
Aortic Valve ◽  
Septal Defect ◽  
Aortic Valve Repair ◽  
Valve Repair ◽  
Basal Ring ◽  
Sinotubular Junction ◽  
Effective Height ◽  
Institutional Experience ◽  
Conotruncal Anomalies ◽  
Geometrical Concepts

Progressive aortic regurgitation can occur in pediatric patients due to root dilation with conotruncal anomalies or cusp prolapse associated with a ventricular septal defect. It is treated using various approaches influenced by personal preferences and institutional experience. We applied geometrical concepts developed for adult aortic valve repair to pediatric valves. The basal ring and sinotubular junction are downsized in relation to the geometric height of the cusp by external suture annuloplasty. The length of the cusp free margin is then adjusted with central plication, guided by measuring the effective height of the cusp. This approach facilitates the reproducibility and predictability of pediatric aortic valve repair.

Techniques of Aortic Valve Repair

2011 ◽  
Vol 6 (6) ◽  
pp. 348-354 ◽  
Author(s):  
J. Scott Rankin ◽  
Jeffrey G. Gaca
Keyword(s):  
Aortic Valve ◽  
Aortic Root ◽  
Free Edge ◽  
Aortic Insufficiency ◽  
Aortic Valve Repair ◽  
Valve Repair ◽  
Aortic Valves ◽  
Mitral Repair ◽  
Cavitron Ultrasonic Surgical Aspirator ◽  
Valve Reconstruction

Similar to mitral repair, newer methods of aortic valve reconstruction are achieving excellent outcomes with an 85% to 90% freedom from valve-related complications at 10 years. The goal of this review is to illustrate these newer and more stable techniques of aortic valve repair. Most patients with aortic insufficiency from either trileaflet or bicuspid aortic valves are candidates for repair, in addition to selected patients with mixed aortic stenosis/insufficiency and aortic root aneurysms. Initially, aggressive commissural annuloplasty is performed to reduce measured valve diameter to 19 to 21 mm. Leaflet prolapse is corrected with plication stitches placed in the free edge of each leaflet adjacent to the Nodulus Arantius. In this regard, the leaflet free edge functions as the chorda tendinea of the aortic valve, and shortening with plication stitches raises the leaflet to a proper “effective height.” Leaflet defects are augmented with gluteraldehyde-fixed autologous pericardium, and mild-to-moderate strategically placed spicules of calcium are removed with the cavitron ultrasonic surgical aspirator. Using these methods, most insufficient aortic valves, and many with mixed lesions, can be satisfactorily repaired. Six cases are illustrated in this review, spanning the spectrum of pathologies from annular dilatation without leaflet defects, to standard congenital bicuspid valve with prolapse, to trileaflet prolapse, to unusual bicuspid pathology with calcification, to a moderately calcified trileaflet valve with mixed lesions, and to aortic root aneurysms with severe aortic insufficiency. All valves were repaired using the techniques described above with trivial residual leak and minimal gradients. All repairs have been followed with yearly echocardiography, and valve reconstruction with these methods is now quite stable with excellent late outcomes. Most insufficient aortic valves now can undergo stable repair with minimal late valve-related complications. Greater application of aortic valve repair seems indicated.

scholarly journals Altered stresses and dynamics after single and double annuloplasty ring for aortic valve repair

2020 ◽  
Vol 57 (6) ◽  
pp. 1210-1217
Author(s):  
Leila Louise Benhassen ◽  
Jacob Hesselby Hedensted ◽  
Mona Sharghbin ◽  
Søren Nielsen Skov ◽  
Lisa Carlson Hanse ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Stress Distribution ◽  
Aortic Root ◽  
Radial Stress ◽  
Aortic Annulus ◽  
Aortic Valve Repair ◽  
Valve Repair ◽  
Annuloplasty Ring ◽  
Double Ring ◽  
Single Ring

Abstract OBJECTIVES Aortic valve repair procedures for the treatment of isolated aortic valve insufficiency may be improved by stabilizing the functional aortic annulus using a double annuloplasty ring at the aortic annulus and sinotubular junction (STJ). The objective of this study was to compare the geometrical changes and aortic root stress distribution when using a single subvalvular ring and a double sub- and supravalvular ring in vivo. METHODS Both the single- and double-ring procedures were performed successively in nine 80-kg pigs. Measurements were performed intraoperatively using sonomicrometry crystals in the aortic root to evaluate geometrical changes and annular and STJ force transducers measuring the segmental radial stress distribution. RESULTS The total force in the STJ was significantly reduced after the double-ring procedure from 1.7 ± 0.6 to 0.04 ± 1.1 N (P = 0.001). The double-ring procedure significantly reduced the STJ area from 234.8 ± 37.6 to 147.5 ± 31.8 mm2 (P = 0.001) and expansibility from 17 ± 6% to 8 ± 3% (P = 0.001). With the single-ring procedure, the STJ shape was circular but became more oval with the double-ring procedure. The double-ring procedure did not affect stress distribution or geometry in the aortic annulus. CONCLUSIONS The double-ring procedure stabilized the whole aortic root by reducing radial stress distribution in the STJ more efficiently than the single-ring procedure. Both area and expansibility were reduced with the double-ring procedure. These results confirm the importance of addressing the entire functional aortic annulus for optimal aortic valve repair procedures.

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