A geometric approach to aortic root surgical anatomy.
OBJECTIVE
The aim of this study was the analysis of the geometrical relationships between the different structures constituting the aortic root, with particular attention to interleaflet triangles, haemodynamic ventriculo-arterial junction and functional aortic annulus in normal subjects.


METHODS
Sixteen formol-fixed human hearts with normal aortic roots were studied. The aortic root was isolated, sectioned at the midpoint of the non-coronary sinus, spread apart and photographed by a high-resolution digital camera. After calibration and picture resizing, the software AutoCAD 2004 was used to identify and measure all the elements of the interleaflets triangles and of the aortic root that were objects of our analysis. Multiple comparisons were performed with one-way analysis of variance for continuous data and with Kruskal-Wallis analysis for non-continuous data. Linear regression and Pearson's product correlation were used to correlate root element dimensions when appropriate. Student's t-test was used to compare means for unpaired data. Heron's formula was applied to estimate the functional aortic annular diameters.


RESULTS
The non coronary-left coronary interleaflets triangles were larger, followed by inter-coronary and right-non-coronary ones. The apical angle is <60° and its standard deviation can be considered an asymmetry index. The sinu-tubular junction was shown to be 10% larger than the virtual basal ring (VBR). The mathematical relationship between the haemodynamic ventriculo-arterial junction and the VBR calculated by linear regression and expressed in terms of the diameter was: haemodynamic ventriculo-arterial junction = 2.29 VBR (diameter) + 47.


CONCLUSIONS
Conservative aortic surgery is based on a better understanding of aortic root anatomy and physiology. The relationships among its elements are of paramount importance during aortic valve repair/sparing procedures and they can be useful also in echocardiographic analysis and in computed tomography reconstruction.
Cardiovascular Surgery Department, Ospedale Luigi Sacco, Milano, Italy monica.contino@gmail.com.
Monica
M
Contino
Cardiovascular Surgery Department, Ospedale Luigi Sacco, Milano, Italy DEIB Department Politecnico di Milano, Milan, Italy.
Andrea
A
Mangini
Cardiovascular Surgery Department, Ospedale Luigi Sacco, Milano, Italy.
Massimo Giovanni
MG
Lemma
Cardiovascular Surgery Department, Ospedale Luigi Sacco, Milano, Italy.
Claudia
C
Romagnoni
Pathology Unit, Institute of Biomedical Sciences, Ospedale Luigi Sacco, Milano, Italy.
Pietro
P
Zerbi
Cardiovascular Surgery Department, Ospedale Luigi Sacco, Milano, Italy.
Guido
G
Gelpi
Cardiovascular Surgery Department, Ospedale Luigi Sacco, Milano, Italy Università degli Studi di Milano, Milan, Italy.
Carlo
C
Antona
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001011:Aorta / Q000033:anatomy & histology* / Q000502:physiology; D001021:Aortic Valve / Q000033:anatomy & histology* / Q000502:physiology / Q000601:surgery; D005260:Female; D006439:Hemodynamics; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged
Aortic root; Aortic valve repair; Haemodynamic ventriculo-arterial junction; Interleaflet triangle; Sinu-tubular junction; Virtual basal ring