Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Functional reconstruction of the aortic root: biomechanics and hemodynamics

Authors: Alibekov D.-S.Ya., Ropova A.I., Savina E.D., Sinyavin G.V., Soborov M.A.

Link: Clinical Physiology of Blood Circulaiton. 2024; 21 (4): 277-289

Download
Full text:  

References

  1. Benjamin E.J., Muntner P., Alonso A., Bittencourt M.S., Callaway C.W., Carson A.P. et al. Heart Disease and Stroke Statistics-2019 Update: a report from the American Heart Association. Circulation. 2019; 139 (10): e56–e528. DOI: 10.1161/CIR.0000000000000659
  2. Vahanian A., Beyersdorf F., Praz F., Milojevic M., Baldus S., Bauersachs J. et al. ESC/EACTS Scientific Document Group. 2021 ESC/ EACTS Guidelines for the management of valvular heart disease. Eur. Heart. J. 2022; 43 (7): 561–632. DOI: 10.1093/eurheartj/ehab395
  3. Yadgir S., Johnson C.O., Aboyans V., Adebayo O.M., Adedoyin R.A., Afarideh M. et al. Global, regional, and national burden of calcific aortic valve and degenerative mitral valve diseases, 1990–2017. Circulation. 2020; 141 (21): 1670–1680. DOI: 10.1161/ CIRCULATIONAHA.119.043391
  4. Nkomo V.T., Gardin J.M., Skelton T.N., Gottdiener J.S., Scott C.G., Enriquez-Sarano M. Burden of valvular heart diseases: a population- based study. Lancet. 2006; 368 (9540): 1005–1011. DOI: 10.1016/S0140-6736(06)69208-8
  5. Anderson R.H. Clinical anatomy of the aortic root. Heart. 2000: 670–673. DOI: 10.1136/heart.84.6.670
  6. Anderson R.H., Devine W.A., Ho S.Y., Smith A., McKay R. The myth of the aortic annulus: the anatomy of the subaortic outflow tract. Ann. Thorac. Surg. 1991; 52 (3): 640–646. DOI: 10.1016/0003-4975(91)90966-t
  7. El Khoury G., Glineur D., Rubay J., Verhelst R., d’Acoz Yd., Poncelet A. et al. Functional classification of aortic root/valve abnormalities and their correlation with etiologies and surgical procedures. Curr. Opin. Cardiol. 2005; 20 (2): 115–121. DOI: 10.1097/01. hco.0000153951.31887.a6
  8. Tamás E., Nylander E. Echocardiographic description of the anatomic relations within the normal aortic root. J. Heart Valve Dis. 2007; 16(3): 240–246. PMID: 17578042.
  9. Anderson R.H. The surgical anatomy of the aortic root. Multimed. Man. Cardiothorac. Surg. 2007 1; 2007 (102): mmcts.2006.002527. DOI: 10.1510/mmcts.2006.002527
  10. Mori S., Anderson R.H., Tahara N., Izawa Y., Toba T., Fujiwara S. et al. The differences between bisecting and off-center cuts of the aortic root: The three-dimensional anatomy of the aortic root reconstructed from the living heart. Echocardiography. 2017; 34 (3): 453–461. DOI: 10.1111/echo.13468. Epub 2017 Feb 3.
  11. Barnard S.J., Haunschild J., Heiser L., Dieterlen M.T., Klaeske K., Borger M.A. et al. Apoptotic cell death in bicuspid-aortic-valve-associated aortopathy. Int. J. Mol. Sci. 2023; 24 (8): 7429. DOI: 10.3390/ijms24087429
  12. Berdajs D., Lajos P., Turina M. The anatomy of the aortic root. Cardiovasc. Surg. 2002; 10 (4): 320–327. DOI: 10.1016/s0967-2109(02)00018-2
  13. Choo S.J., McRae G., Olomon J.P., St George G., Davis W., Burleson-Bowles C.L. et al. Aortic root geometry: pattern of differences between leaflets and sinuses of Valsalva. J. Heart Valve Dis. 1999; 8 (4): 407–415. PMID: 10461241.
  14. Morbiducci U., Ponzini R., Rizzo G., Cadioli M., Esposito A., Montevecchi F.M. et al. Mechanistic insight into the physiological relevance of helical blood flow in the human aorta: an in vivo study. Biomech. Model. Mechanobiol. 2011; 10 (3): 339–355. DOI: 10.1007/s10237-010-0238-2. Epub 2010 Jul 22.
  15. Pisani G., Scaffa R., Ieropoli O., Dell’Amico E.M., Maselli D., Morbiducci U., De Paulis R. Role of the sinuses of Valsalva on the opening of the aortic valve. J. Thorac. Cardiovasc. Surg. 2013; 145 (4): 999–1003. DOI: 10.1016/j.jtcvs.2012.03.060. Epub 2012 Apr 13.
  16. Higashidate M., Tamiya K., Beppu T., Imai Y. Regulation of the aortic valve opening. In vivo dynamic measurement of aortic valve orifice area. J. Thorac. Cardiovasc. Surg. 1995; 110 (2): 496–503. DOI: 10.1016/S0022-5223(95)70246-6
  17. Brewer R.J., Deck J.D., Capati B., Nolan S.P. The dynamic aortic root. Its role in aortic valve function. J. Thorac. Cardiovasc. Surg. 1976; 72 (3): 413–417. PMID: 957758.
  18. Бритиков Д.В., Сачков А.С., Муратов Р.М. Функциональная анатомия, биомеханика и гемодинамика аортального клапана. Различные типы протезов в аортальной позиции. Клиническая физиология кровообращения. 2008: 2; 18–34.
  19. Brewer R.J., Mentzer R.M. Jr, Deck J.D., Ritter R.C., Trefil J.S., Nolan S.P. An in vivo study of the dimensional changes of the aortic valve leaflets during the cardiac cycle. J. Thorac. Cardiovasc. Surg. 1977; 74 (4): 645–650. PMID: 904366.
  20. Thubrikar M., Nolan S.P., Bosher L.P., Deck J.D. The cyclic changes and structure of the base of the aortic valve. Am. Heart J. 1980; 99 (2): 217–224. DOI: 10.1016/0002-8703(80)90768-1
  21. Cheng A., Dagum P., Miller D.C. Aortic root dynamics and surgery: from craft to science. Philos. Trans. R. Soc. Lond. B. Biol. Sci. 2007; 362 (1484): 1407–1419. DOI: 10.1098/rstb.2007.2124
  22. Dagum P., Green G.R., Nistal F.J., Daughters G.T., Timek T.A., Foppiano L.E. et al. Deformational dynamics of the aortic root: modes and physiologic determinants. Circulation. 1999; 100 (19 Suppl.): II54–62. DOI: 10.1161/01.cir.100.suppl_2.ii-54
  23. Bellhouse B.J. Fluid mechanics of the aortic valve. In: Baan J., Arntzenius A.C., Yellin E.L. (Eds) Cardiac Dynamics. Developments Cardiovasc. Med. 1980: 2; 489–496. DOI: 10.1007/978-94-009-8796-8_45
  24. Zimmerman J. The functional and surgical anatomy of the aortic valve. Isr. J. Med. Sci. 1969; 5 (4): 862–866. PMID: 5820535.
  25. Frank O. The basic shape of the arterial pulse. First treatise: mathematical analysis. 1899. J. Mol. Cell. Cardiol. 1990; 22 (3): 255–277. DOI: 10.1016/0022-2828(90)91460-o
  26. Mei C.C., Zhang J., Jing H.X. Fluid mechanics of Windkessel effect. Med. Biol. Eng. Comput. 2018; 56 (8): 1357–1366. DOI: 10.1007/s11517-017-1775-y. Epub 2018 Jan 8.
  27. Davies J.E., Parker K.H., Francis D.P., Hughes A.D., Mayet J. What is the role of the aorta in directing coronary blood flow? Heart. 2008; 94(12): 1545–1547. DOI: 10.1136/hrt.2008.144808
  28. Bremer J.L. The presence and influence of two spiral streams in the heart of the chick embryo. Am. J. Anat. 1932; 49 (3): 409–440. DOI: 10.1002/aja.1000490305
  29. Chandran K.B. Flow dynamics in the human aorta. J. Biomech. Eng. 1993; 115 (4B): 611–616. DOI: 10.1115/1.2895548
  30. Жоржолиани Ш.Т., Талыгин Е.А., Крашенинников С.В., Цыганков Ю.М., Агафонов А.В., Городков А.Ю. и др. Изменение упругости вдоль аорты как один из механизмов поддержания физиологически адекватной смерчеобразной структуры потока крови. Физиология человека. 2018; 5: 47–56. DOI: 10.1134/s013116461805017x
  31. Talygin E.A., Zhorzholiani S.T., Tkhagapsova M.M., Tsygankov Yu.M., Agafonov A.V., Gorodkov A.Yu. et al. Reconstruction of swirling blood flow in the heart and aorta on the basis of measurements of dynamic geometry and elastic properties of the flow channel. Proceedings of the ASME 2018 International Mechanical Engineering Congress and Exposition. Vol. 3: Biomedical and Biotechnology Engineering. Pittsburgh, Pennsylvania, USA. November 9–15, 2018. V003T04A052. ASME. DOI: 10.1115/imece2018-87680
  32. Багаев С.Н., Захаров В.Н., Орлов В.А. О необходимости винтового движения крови. Российский журнал биомеханики. 2002; 4: 30– 51.
  33. De Nisco G., Hoogendoorn A., Chiastra C., Gallo D., Kok A.M., Morbiducci U. et al. The impact of helical flow on coronary atherosclerotic plaque development. Atherosclerosis. 2020; 300: 39–46. DOI: 10.1016/j.atherosclerosis.2020.01.027. Epub 2020 Feb 7.
  34. Gallo D., Bijari P.B., Morbiducci U., Qiao Y., Xie Y.J., Etesami M. et al. Segment-specific associations between local haemodynamic and imaging markers of early atherosclerosis at the carotid artery: an in vivo human study. J. R. Soc. Interface. 2018; 15 (147): 20180352. DOI: 10.1098/rsif.2018.0352
  35. Mohamied Y., Rowland E.M., Bailey E.L., Sherwin S.J., Schwartz M.A., Weinberg P.D. Change of direction in the biomechanics of atherosclerosis. Ann. Biomed. Eng. 2015; 43 (1): 16–25. DOI: 10.1007/s10439-014-1095-4. Epub 2014 Aug 20.
****
  1. Benjamin E.J., Muntner P., Alonso A., Bittencourt M.S., Callaway C.W., Carson A.P. et al. Heart Disease and Stroke Statistics-2019 Update: a report from the American Heart Association. Circulation. 2019; 139 (10): e56–e528. DOI: 10.1161/CIR.0000000000000659
  2. Vahanian A., Beyersdorf F., Praz F., Milojevic M., Baldus S., Bauersachs J. et al. ESC/EACTS Scientific Document Group. 2021 ESC/ EACTS Guidelines for the management of valvular heart disease. Eur. Heart. J. 2022; 43 (7): 561–632. DOI: 10.1093/eurheartj/ehab395
  3. Yadgir S., Johnson C.O., Aboyans V., Adebayo O.M., Adedoyin R.A., Afarideh M. et al. Global, regional, and national burden of calcific aortic valve and degenerative mitral valve diseases, 1990–2017. Circulation. 2020; 141 (21): 1670–1680. DOI: 10.1161/ CIRCULATIONAHA.119.043391
  4. Nkomo V.T., Gardin J.M., Skelton T.N., Gottdiener J.S., Scott C.G., Enriquez-Sarano M. Burden of valvular heart diseases: a population- based study. Lancet. 2006; 368 (9540): 1005–1011. DOI: 10.1016/S0140-6736(06)69208-8
  5. Anderson R.H. Clinical anatomy of the aortic root. Heart. 2000: 670–673. DOI: 10.1136/heart.84.6.670
  6. Anderson R.H., Devine W.A., Ho S.Y., Smith A., McKay R. The myth of the aortic annulus: the anatomy of the subaortic outflow tract. Ann. Thorac. Surg. 1991; 52 (3): 640–646. DOI: 10.1016/0003-4975(91)90966-t
  7. El Khoury G., Glineur D., Rubay J., Verhelst R., d’Acoz Yd., Poncelet A. et al. Functional classification of aortic root/valve abnormalities and their correlation with etiologies and surgical procedures. Curr. Opin. Cardiol. 2005; 20 (2): 115–121. DOI: 10.1097/01. hco.0000153951.31887.a6
  8. Tamás E., Nylander E. Echocardiographic description of the anatomic relations within the normal aortic root. J. Heart Valve Dis. 2007; 16(3): 240–246. PMID: 17578042.
  9. Anderson R.H. The surgical anatomy of the aortic root. Multimed. Man. Cardiothorac. Surg. 2007 1; 2007 (102): mmcts.2006.002527. DOI: 10.1510/mmcts.2006.002527
  10. Mori S., Anderson R.H., Tahara N., Izawa Y., Toba T., Fujiwara S. et al. The differences between bisecting and off-center cuts of the aortic root: The three-dimensional anatomy of the aortic root reconstructed from the living heart. Echocardiography. 2017; 34 (3): 453–461. DOI: 10.1111/echo.13468. Epub 2017 Feb 3.
  11. Barnard S.J., Haunschild J., Heiser L., Dieterlen M.T., Klaeske K., Borger M.A. et al. Apoptotic cell death in bicuspid-aortic-valve-associated aortopathy. Int. J. Mol. Sci. 2023; 24 (8): 7429. DOI: 10.3390/ijms24087429
  12. Berdajs D., Lajos P., Turina M. The anatomy of the aortic root. Cardiovasc. Surg. 2002; 10 (4): 320–327. DOI: 10.1016/s0967-2109(02)00018-2
  13. Choo S.J., McRae G., Olomon J.P., St George G., Davis W., Burleson-Bowles C.L. et al. Aortic root geometry: pattern of differences between leaflets and sinuses of Valsalva. J. Heart Valve Dis. 1999; 8 (4): 407–415. PMID: 10461241.
  14. Morbiducci U., Ponzini R., Rizzo G., Cadioli M., Esposito A., Montevecchi F.M. et al. Mechanistic insight into the physiological relevance of helical blood flow in the human aorta: an in vivo study. Biomech. Model. Mechanobiol. 2011; 10 (3): 339–355. DOI: 10.1007/s10237-010-0238-2. Epub 2010 Jul 22.
  15. Pisani G., Scaffa R., Ieropoli O., Dell’Amico E.M., Maselli D., Morbiducci U., De Paulis R. Role of the sinuses of Valsalva on the opening of the aortic valve. J. Thorac. Cardiovasc. Surg. 2013; 145 (4): 999–1003. DOI: 10.1016/j.jtcvs.2012.03.060. Epub 2012 Apr 13.
  16. Higashidate M., Tamiya K., Beppu T., Imai Y. Regulation of the aortic valve opening. In vivo dynamic measurement of aortic valve orifice area. J. Thorac. Cardiovasc. Surg. 1995; 110 (2): 496–503. DOI: 10.1016/S0022-5223(95)70246-6
  17. Brewer R.J., Deck J.D., Capati B., Nolan S.P. The dynamic aortic root. Its role in aortic valve function. J. Thorac. Cardiovasc. Surg. 1976; 72 (3): 413–417. PMID: 957758.
  18. Britikov D.V., Sachkov A.S., Muratov R.M. Functional anatomy, biomechanics and hemodynamics of the aortic valve. Various types of prostheses in the aortic position. Clinical Physiology of Circulation. 2008; 2: 18–34 (in Russ.).
  19. Brewer R.J., Mentzer R.M. Jr, Deck J.D., Ritter R.C., Trefil J.S., Nolan S.P. An in vivo study of the dimensional changes of the aortic valve leaflets during the cardiac cycle. J. Thorac. Cardiovasc. Surg. 1977; 74 (4): 645–650. PMID: 904366.
  20. Thubrikar M., Nolan S.P., Bosher L.P., Deck J.D. The cyclic changes and structure of the base of the aortic valve. Am. Heart J. 1980; 99 (2): 217–224. DOI: 10.1016/0002-8703(80)90768-1
  21. Cheng A., Dagum P., Miller D.C. Aortic root dynamics and surgery: from craft to science. Philos. Trans. R. Soc. Lond. B. Biol. Sci. 2007; 362 (1484): 1407–1419. DOI: 10.1098/rstb.2007.2124
  22. Dagum P., Green G.R., Nistal F.J., Daughters G.T., Timek T.A., Foppiano L.E. et al. Deformational dynamics of the aortic root: modes and physiologic deter minants. Circulation. 1999; 100 (19 Suppl.): II54–62. DOI: 10.1161/01.cir.100.suppl_2.ii-54
  23. Bellhouse B.J. Fluid mechanics of the aortic valve. In: Baan J., Arntzenius A.C., Yellin E.L. (Eds) Cardiac Dynamics. Developments Cardiovasc. Med. 1980: 2; 489–496. DOI: 10.1007/978-94-009-8796-8_45
  24. Zimmerman J. The functional and surgical anatomy of the aortic valve. Isr. J. Med. Sci. 1969; 5 (4): 862–866. PMID: 5820535.
  25. Frank O. The basic shape of the arterial pulse. First treatise: mathematical analysis. 1899. J. Mol. Cell. Cardiol. 1990; 22 (3): 255–277. DOI: 10.1016/0022-2828(90)91460-o
  26. Mei C.C., Zhang J., Jing H.X. Fluid mechanics of Windkessel effect. Med. Biol. Eng. Comput. 2018; 56 (8): 1357–1366. DOI: 10.1007/s11517-017-1775-y. Epub 2018 Jan 8.
  27. Davies J.E., Parker K.H., Francis D.P., Hughes A.D., Mayet J. What is the role of the aorta in directing coronary blood flow? Heart. 2008; 94(12): 1545–1547. DOI: 10.1136/hrt.2008.144808
  28. Bremer J.L. The presence and influence of two spiral streams in the heart of the chick embryo. Am. J. Anat. 1932; 49 (3): 409–440. DOI: 10.1002/aja.1000490305
  29. Chandran K.B. Flow dynamics in the human aorta. J. Biomech. Eng. 1993; 115 (4B): 611–616. DOI: 10.1115/1.2895548
  30. Zhorzholiani S.T., Talygin E.A., Krasheninnikov S.V., Tsigankov Y.M., Agafonov A.V., Gorodkov A.Yu. et al. Elasticity change along the aorta is a mechanism for supporting the physiological self-organization of tornado-like blood flow. Human Physiology. 2018; 5: 47–56 (in Russ.). DOI: 10.1134/s013116461805017x
  31. Talygin E.A., Zhorzholiani S.T., Tkhagapsova M.M., Tsygankov Yu.M., Agafonov A.V., Gorodkov A.Yu. et al. Reconstruction of swirling blood flow in the heart and aorta on the basis of measurements of dynamic geometry and elastic properties of the flow channel. Proceedings of the ASME 2018 International Mechanical Engineering Congress and Exposition. Vol. 3: Biomedical and Biotechnology Engineering. Pittsburgh, Pennsylvania, USA. November 9–15, 2018. V003T04A052. ASME. DOI: 10.1115/imece2018-87680
  32. Bagaev S.N., Zakharov V.N., Orlov V.A. The need for a spiral movement of blood. Russian Journal of Biomechanics. 2002; 4: 30–51 (in Russ.).
  33. De Nisco G., Hoogendoorn A., Chiastra C., Gallo D., Kok A.M., Morbiducci U. et al. The impact of helical flow on coronary atherosclerotic plaque development. Atherosclerosis. 2020; 300: 39–46. DOI: 10.1016/j.atherosclerosis.2020.01.027. Epub 2020 Feb 7.
  34. Gallo D., Bijari P.B., Morbiducci U., Qiao Y., Xie Y.J., Etesami M. et al. Segment-specific associations between local haemodynamic and imaging markers of early atherosclerosis at the carotid artery: an in vivo human study. J. R. Soc. Interface. 2018; 15 (147): 20180352. DOI: 10.1098/rsif.2018.0352
  35. Mohamied Y., Rowland E.M., Bailey E.L., Sherwin S.J., Schwartz M.A., Weinberg P.D. Change of direction in the biomechanics of atherosclerosis. Ann. Biomed. Eng. 2015; 43 (1): 16–25. DOI: 10.1007/s10439-014-1095-4. Epub 2014 Aug 20.

 If you found mistakes, select text and press Alt+A