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


Анатомическое обоснование трехмерных моделей корня аорты человека

E-mail: Сведения доступны для зарегистрированных пользователей.

Link: Clinical Physiology of Blood Circulaiton. 2013; (): -

Full text:  

Abstract

Objective. Construction of spatial three-dimensional computed models of the human aortic root on the basis of records received by the method of the multislice spiral computed tomoangiography and echocardiography.

Material and methods. The work has analysed the records received by transthoracic echocardiography. 117 patients were reported at the age of 18 to 81 years old with both the aortic valve insufficiency (regurgitation of 1st -4th stages, aortic stenosis of 1st-4th stages) (N=58) and without aortic insufficiency (N=59). For the purpose of volume visualization of sinuses of Valsalva the records of 20 patients without aortic valve insufficiency at the age of 60 to 65 years old who were examined by the coronary multislice spiral computed tomoangiography have been additionally analysed. On the basis of the records within the automatized designing we have constructed the three-dimensional models.

Results. In order to determine the main type-sizes the records of echocardiography were grouped depending on the diameter of the fibrous ring in diastole. The indication analysis in groups has shown the following reading for the diameter of fibrous ring: in group no.19 - 1.85±0.07 cm, in group no. 21 - 2.05±0.05 cm, no. 23 - 2.26±0.06 cm, no. 25 - 2.52±0.10 cm. Diameter of the sinotubular junction has made up: for group no.19 - 2.91±0.29 cm, no. 21 - 3.11±0.40 cm, no. 23 - 3.22±0.61 cm, no. 25 - 3.69±0.44 cm. There were no statistically significant differences between groups as for the distance from the fibrous ring to the sinotubular junction: 2.36 cm (quartile: 1.97 - 2.49 cm). The results of multislice spiral computed tomoangiography have not been grouped as during the statistical processing no correlation has been found between the diameter of the fibrous ring and such parameters as: 1) right (ρ=0.05) and left (ρ=0.02) angle of the socket of the ascending aorta, 2) distance from the fibrous ring to the orifice of right (ρ=0.27) and left (ρ=0.1) coronary arteries, 3) depth of sinuses of Valsalva (relatively of the right coronary cusp ρ=0.33; left coronary cusp ρ=0.19; non-coronary cusp ρ=0.02). Upon the results analysis of echocardiography and multislice spiral computed tomoangiography the four three-dimensional models of the human aortic root with diameter of fibrous ring of 19 mm, 21 mm, 23 mm and 25 mm have been created. 

Conclusion. As a result of the present research based on echocardiography and multislice spiral computed tomoangiography the four models of human aortic root have been received and grouped depending on the fibrous ring diameter. Models can be used for computer simulation of interaction between the valve prosthesis and the aorta. Such approach while developing the new types of prosthetic heart valves may simplify designing and predict potential risks and complications regarding implantation of such devices.

References

Влад А. Р., Семенов С. Е., Коков А. Н. и др. Возможности МСКТ ангиографии в морфометрии корня аорты // Лучевая диагн. и тер. 2012. № 2 (3). С. 73-79.
Константинов Б.А., Прелатов В.А., Иванов В.А., Малиновская Т.Н. Клапансберегающие реконструктивные операции в хирургии пороков сердца. М.: Медицина, 1989. 143 с.
Conti M., De Beule M., Mortier P. et al. Nitinol embolic protection filters: Design investigation by finite element analysis // J. Mater. Engineer. Perform. 2009. Vol. 18. P. 787-792.
De Carlo M., Giannini C., Ettori F. et al. Impact of treatment choice on the outcome of patients proposed for transcatheter aortic valve implantation // EuroIntervention. 2010. Vol. 6. P. 568-574.
Delgado V., Ewe S.H., Ng A.C. et al. Multimodality imaging in transcatheter aortic valve implantation: key steps to assess procedural feasibility // Eurointervention. 2010. Vol. 6, № 5. P. 643-652.
Gnyaneshwar R., Kumar R.K., Balakrishnan K.R. Dynamic analysis of the aortic valve using a finite element model // Ann. Thorac. Surg. 2002. Vol. 73, № 4. P. 1122-1129.
Hammer P.E., Chen C.P., del Nido P.J. et al. Computational model of aortic valve surgical repair using grafted pericardium // J. Biomech. 2012. Vol. 12, № 7. P. 1199-1204.
Hopkins R. A. Aortic valve leaflet sparing and salvage surgery: Evolution of techniques for aortic root reconstruction // Eur. J. Cardiothorac. Surg. 2003. Vol. 24. P. 886-897.
Iung B. Management of the elderly patient with aortic stenosis // Heart. 2008. Vol. 94. P. 519-524.
Iung B., Cachier A., Baron G. et al. Decision-making in elderly patients with severe aortic stenosis: Why are so many denied surgery? // Eur. Heart J. 2005. Vol. 26. P. 2714-2720.
ISO 5840:2005 Cardiovascular implants - Cardiac valve prostheses
Jian Ye, Jia Lin Soon, Webb J. Aortic valve replacement vs. transcatheter aortic valve implantation: Patient selection // Ann. Cardiothoracic. Surg. 2012. Vol. 1, № 2. P. 96-99.
Joudinaud T.M., Flecher E.M., Curry J.W. et al. Sutureless stented aortic valve implantation under direct vision: Lessons from a negative experience in sheep // J. Card. Surg. 2007. Vol. 22, № 1. P. 13-17.
Kojodjojo P., Gohil N., Barker D. et al. Outcomes of elderly patients aged 80 and over with symptomatic, severe aortic stenosis: Impact of patient's choice of refusing aortic valve replacement on survival // Q. J. Med. 2008. Vol. 101. P. 567-573.
Kolh P., Lahaye L., Gerard P. et al. Aortic valve replacement in the octogenarians: Perioperative outcome and clinical follow-up // Eur. J. Cardiothoracic. Surg. 1999. Vol. 16. P. 68-73.
Leon M.B., Smith C.R., Mack M. et al. PARTNER Trial Investigators: Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery // N. Engl. J. Med. 2010. Vol. 363. P. 1597-1607.
Lindroos M., Kupari M., Heikkilд J. et al. Prevalence of aortic valve abnormalities in the elderly: An echocardiographic study of a random population sample // J. Am. Coll. Cardiol. 1993. Vol. 21. P. 1220-1225.
Piazza N., de Jaegere P., Schultz C. et al. Anatomy of the aortic valvar complex and its implications for transcatheter implantation of the aortic valve // Circ. Cardiovasc. Interv. 2008. Vol. 1, № 1. P. 74-81.
Schultz C.J., Moelker A., Piazza N. et al. Three dimensional evaluation of the aortic annulus using multislicecomputer tomography: Are manufacturer's guidelines for sizing for percutaneous aortic replacement helpful? // Eur. Heart J. 2010. Vol. 31, № 7. P. 849-856.
Schultz C.J., Weustink A., Piazza N. et al. Geometry and degree of apposition of the CoreValve ReValving system with multislice computed tomography after implantation in patients with aortic stenosis // J. Am. Coll. Cardiol. 2009. Vol. 1; 54, № 10. P. 911-918.
Tamбs E., Nylander E. Echocardiographic description of the anatomic relations within the normal aortic root // J. Heart Valve Dis. 2007. Vol. 16, № 3. P. 240-246.
Tops L.F., Wood D.A., Delgado V. et al. Noninvasive evaluation of the aortic root with multislice computed tomography implications for transcatheter aortic valve replacement // JACC Cardiovasc. Imaging. 2008. Vol. 1, № 3. P. 321-330.
Turillazzi E., Giammarco G., Neri M. et al. Coronary ostia obstruction after replacement of aortic valve prosthesis // J. Diagn. Pathol. 2011. Vol. 6. P. 123-129.
Zhu D. et al. Dynamic normal aortic root diameters: Implications for aortic root reconstruction // J. Ann. Thorac. Surg. 2011. Vol. 91, № 2. P. 485-489.
Zoghbi W.A., Chambers J.B., Dumesnil J.G. et al. Recommen-dations for evaluation of prosthetic valves with echocardiography and Doppler ultrasound // J. Am. Soc. Echocardiogr. 2009. Vol. 22, № 9. P. 975-1014.

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