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A Simple Method To Estimate Functional Aortic Annulus Dimensions
Andrea Mangini, Monica Contino, Claudia Romagnoni, Massimo Lemma, Guido Gelpi, Paolo Vanelli, Pietro Zerbi,
Carlo Antona.
L sacco University Hospital, Milano, Italy.

ABSTRACT: A simple method to estimate functional aortic annulus dimensions OBJECTIVE: Sparing techniques and aortic valve repair procedures have changed the surgical view of the Aortic Root (AR). Features described by anatomist have been integrated by surgeons into their cultural burden, who now look at the aortic valve as a functional unit, in the form of a continuum embracing structure and function. Conservative aortic valve surgery is based on better understanding of aortic root anatomy and dynamics. From the analysis of anatomical relationships we can get some indications useful during aortic root surgeries, especially about functional aortic annulus. METHODS: We photographed 16 formol-fixed human hearts with normal aortic roots to be analyzed and measured with a computer aided design software. Using Commissural Distance (CD) and Sinuses of Valsalva Nadir Distances (SVND) measures it was possible to esteem the virtual basal ring (VBR) and the Sino-Tubular Junction (STJ), representing respectively the inlet and the outlet diameter of the AR, both computed assuming their shape as circular. The estimated VBR (eVBR) was defined as the discrete circular distal boundary of the root where the valvular leaflet are peripherally attached. The estimated STJ (eSTJ) was defined as the circumscribed circumference of the triangle delimited by the apexes of the 3 commissures. To reduce the measurement errors due to the 2D configuration we averaged the value of the circumferences measured adding the 3 SVND (linear VBR-lVBR) and the 3 CD (linear STJ-lSTJ) to the circumscribed circles calculated using the Heron's formula (cSTJ-cVBR). This was possible after checking with the Carnot Theorem that the angles amplitudes were inferior to 90°. Diameters were calculated using the formula of the circumference (C=2πr). RESULTS: lVBR was 69.06±6.82, cVBR 86.30±8.46, lSTJ 76.67±7.69 and cSTJ 94.10±+9.54 so eVBR resulted 77.68±7.4 and eSTJ 85.38±8.60. The ratio between VBR and STJ was 1.11±0.17. CONCLUSIONS: We propose a simple method to estimate the VBR and the STJ measures from the SVND and the CD lengths. This will help surgeons to better calculate the correct size of ascending aorta prosthesis and to standardize the reparative approach to the aortic root functional unit.

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