title: Significant increase of aortic root volume and commissural area occurs prior to aortic valve opening.
abstract: OBJECTIVE
  The increased use of autologous, homologous or heterologous aortic root demands a detailed knowledge of its anatomy and function. The advent of 3-D digital sonomicrometry offered the opportunity to acquire precise information on the root and leaflet movements during the cardiac cycle.
  
  
  METHODS
  Under cardiopulmonary bypass, sonomicrometry crystals were implanted in the aortic root and valve of eight sheep. Crystals were sutured at each commissure (n = 3), the top of the sinotubular junction (n = 3), lowest point of the annulus (n = 3), and leaflet tip (n = 3). 3-D coordinates of each crystal were recorded, together with left ventricular and aortic root pressures and ECG. When the animal had returned to a stable hemodynamic condition, the maximum and minimum distances between two crystals, and areas between three crystals, were calculated. Changes in root volume and leaflet position were time-related to the pressure changes.
  
  
  RESULTS
  The most significant change between maximum and minimum distance between crystals during the cardiac cycle occurred at the commissural level. Similarly, the triangle defined by the three commissural crystals showed the greatest change in area (47%). The root volume increased by an average of 22%; about 40% of this increase occurred during the isovolumic phase. The aortic leaflets began to open before ejection.
  
  
  CONCLUSIONS
  We postulate that aortic valve opening is initiated by the outward pull of the commissures. These findings should impact on aortic root surgery.
authors.affiliation: The International Heart Institute of Montana Foundation at St. Patrick Hospital and The University of Montana, Missoula, USA.
authors.forename: D C
authors.initials: DC
authors.lastname: Pang
authors.forename: S J
authors.initials: SJ
authors.lastname: Choo
authors.forename: H H
authors.initials: HH
authors.lastname: Luo
authors.forename: Y U
authors.initials: YU
authors.lastname: Shomura
authors.forename: S
authors.initials: S
authors.lastname: Daniel
authors.forename: S
authors.initials: S
authors.lastname: Nikolic
authors.forename: D T
authors.initials: DT
authors.lastname: Cheung
authors.forename: J H
authors.initials: JH
authors.lastname: Oury
authors.forename: C M
authors.initials: CM
authors.lastname: Duran
mesh_terms: D000818:Animals; D001021:Aortic Valve / Q000033:anatomy & histology* / Q000502:physiology; D006321:Heart / Q000502:physiology*; D009200:Myocardial Contraction / Q000502:physiology; D012756:Sheep; D016277:Ventricular Function, Left; D017725:Ventricular Pressure