title: Role of the sinuses of Valsalva on the opening of the aortic valve.
abstract: OBJECTIVE
  The present in vitro study was designed to ascertain whether the presence of sinuses of Valsalva in the aortic root were able to regulate the valve effective orifice area and modulate the gradient across the valve independently from root compliance.
  
  
  METHODS
  Four different root configurations were prepared. Of the 4, 2 were silicon configurations with the same compliance, 1 with and 1 without sinuses of Valsalva, in which a 25-mm Solo stentless aortic valve was sutured inside. The other 2 configurations were obtained by substituting the upper part of the root with a straight Dacron graft or with a Valsalva graft in a remodeling fashion to reproduce the surgical situation. All roots were mounted in a pulse duplicator to measure the pressure decrease across the valve and effective orifice area at different cardiac outputs.
  
  
  RESULTS
  With increasing cardiac output up to 7 L/min, an increase in the pressure decrease across the valve was evident in both configurations without sinuses of Valsalva (7.90 ± 1.7 and 11 mm Hg ± 0.1 mm Hg, respectively) but not in those with sinuses (2.87 ± 0.5 and 2.42 mm Hg ± 0.5 mm Hg). Similarly, with increasing cardiac output, the effective orifice area increased significantly only in the roots with sinuses (5.13 ± 0.5 and 5.47 ± 0.5 vs 3.06 ± 0.3 and 2.50 cm(2) ± 0.02 cm(2), respectively).
  
  
  CONCLUSIONS
  When the cardiac output is increased to greater than the resting physiologic values, the presence of sinuses of Valsalva, independently of root compliance, prevents an increase in the pressure decrease across the valve by way of an increase of the effective orifice area.
authors.affiliation: Department of Mechanics, Politecnico di Torino, Turin, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pisani
authors.affiliation: Department of Cardiac Surgery, European Hospital, Rome, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Scaffa
authors.affiliation: Sorin Biomedica, Saluggia, Italy.
authors.forename: Ornella
authors.initials: O
authors.lastname: Ieropoli
authors.affiliation: Sorin Biomedica, Saluggia, Italy.
authors.forename: Edoardo M
authors.initials: EM
authors.lastname: Dell'Amico
authors.affiliation: Department of Cardiac Surgery, European Hospital, Rome, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Maselli
authors.affiliation: Department of Mechanics, Politecnico di Torino, Turin, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Morbiducci
authors.affiliation: Department of Cardiac Surgery, European Hospital, Rome, Italy. Electronic address: depauli@tin.it.
authors.forename: Ruggero
authors.initials: R
authors.lastname: De Paulis
mesh_terms: D001021:Aortic Valve / Q000502:physiology*; D008955:Models, Cardiovascular; D012850:Sinus of Valsalva / Q000502:physiology*