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Geometry of cusp and root determines aortic valve function

  • Shunsuke Matsushima
  • Irem Karliova
  • Simon Gauer
  • Shunsuke Miyahara
  • Hans-Joachim SchäfersEmail author
Review Article
  • 17 Downloads

Abstract

The aortic valve is the functional unit of cusp and root. Various geometrical and functional analyses for the aortic valve unit have been executed to understand normal valve configuration and improve aortic valve repair. Different concepts and procedures have then been proposed for reparative approach, and aortic valve repair is still not standardized like mitral valve repair. It has become apparent, however, that interpretation of the geometry of the aortic cusp and root and its appropriate application to operative strategy lead to creating a functioning aortic valve. Herein, the aortic valve geometry and its clinical implications are reviewed to provide information for the selection of appropriate operative strategies.

Keywords

Aortic valve repair Aortic valve geometry Cusp effective height 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Not required.

References

  1. 1.
    Taylor WJ, Thrower WB, Black H, Harken DE. The surgical correction of aortic insufficiency by circumclusion. J Thorac Surg. 1958;35:192–205.Google Scholar
  2. 2.
    Carpentier A. Cardiac valve surgery--the "French correction". J Thorac Cardiovasc Surg. 1983;86:323–37.Google Scholar
  3. 3.
    Duran CG. Reconstructive techniques for rheumatic aortic valve disease. J Card Surg. 1988;3:23–8.CrossRefGoogle Scholar
  4. 4.
    Cosgrove DM, Rosenkranz ER, Hendren WG, Bartlett JC, Stewart WJ. Valvuloplasty for aortic insufficiency. J Thorac Cardiovasc Surg. 1991;102:571–6.Google Scholar
  5. 5.
    Frater RW. Aortic valve insufficiency due to aortic dilatation: correction by sinus rim adjustment. Circulation. 1986;74:I136–42.Google Scholar
  6. 6.
    Sarsam MA, Yacoub M. Remodeling of the aortic valve anulus. J Thorac Cardiovasc Surg. 1993;105:435–8.Google Scholar
  7. 7.
    David TE, Feindel CM. An aortic valve-sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta. J Thorac Cardiovasc Surg. 1992;103:617–21.Google Scholar
  8. 8.
    Schäfers HJ, Schmied W, Marom G, Aicher D. Cusp height in aortic valves. J Thorac Cardiovasc Surg. 2013;146:269–74.CrossRefGoogle Scholar
  9. 9.
    Schäfers HJ, Aicher D, Riodionycheva S, et al. Bicuspidization of the unicuspid aortic valve: a new reconstructive approach. Ann Thorac Surg. 2008;85:2012–8.CrossRefGoogle Scholar
  10. 10.
    Anderson RH. Clinical anatomy of the aortic root. Heart. 2000;84:670–3.CrossRefGoogle Scholar
  11. 11.
    de Kerchove L, Jashari R, Boodhwani M, et al. Surgical anatomy of the aortic root: implication for valve-sparing reimplantation and aortic valve annuloplasty. J Thorac Cardiovasc Surg. 2015;149:425–33.CrossRefGoogle Scholar
  12. 12.
    Khelil N, Sleilaty G, Palladino M, et al. Surgical anatomy of the aortic annulus: landmarks for external annuloplasty in aortic valve repair. Ann Thorac Surg. 2015;99:1220–6.CrossRefGoogle Scholar
  13. 13.
    Evangelista A, Flachskampf FA, Erbel R, et al. Echocardiography in aortic diseases: EAE recommendations for clinical practice. Eur J Echocardiogr. 2010;11:645–58.CrossRefGoogle Scholar
  14. 14.
    Duran CM, Gometza B, Shahid M, Al-Halees Z. Treated bovine and autologous pericardium for aortic valve reconstruction. Ann Thorac Surg. 1998;66:S166–9.CrossRefGoogle Scholar
  15. 15.
    Casselman FP, Gillinov AM, Akhrass R, Kasirajan V, Blackstone EH, Cosgrove DM. Intermediate-term durability of bicuspid aortic valve repair for prolapsing leaflet. Eur J Cardiothorac Surg. 1999;15:302–8.CrossRefGoogle Scholar
  16. 16.
    Pethig K, Milz A, Hagl C, Harringer W, Haverich A. Aortic valve reimplantation in ascending aortic aneurysm: risk factors for early valve failure. Ann Thorac Surg. 2002;73:29–33.CrossRefGoogle Scholar
  17. 17.
    Swanson M, Clark RE. Dimensions and geometric relationships of the human aortic valve as a function of pressure. Circ Res. 1974;35:871–82.CrossRefGoogle Scholar
  18. 18.
    Kunzelman KS, Grande KJ, David TE, Cochran RP, Verrier ED. Aortic root and valve relationships. Impact on surgical repair. J Thorac Cardiovasc Surg. 1994;107:162–70.Google Scholar
  19. 19.
    Schäfers HJ, Aicher D, Langer F, Lausberg HF. Preservation of the bicuspid aortic valve. Ann Thorac Surg. 2007;83:S740–5.CrossRefGoogle Scholar
  20. 20.
    Schäfers HJ, Bierbach B, Aicher D. A new approach to the assessment of aortic cusp geometry. J Thorac Cardiovasc Surg. 2006;132:436–8.CrossRefGoogle Scholar
  21. 21.
    Bierbach BO, Aicher D, Issa OA, et al. Aortic root and cusp configuration determine aortic valve function. Eur J Cardiothorac Surg. 2010;38:400–6.CrossRefGoogle Scholar
  22. 22.
    De Kerchove L, Momeni M, Aphram G, et al. Free margin length and coaptation surface area in normal tricuspid aortic valve: an anatomical study. Eur J Cardiothorac Surg. 2018;53:1040–8.CrossRefGoogle Scholar
  23. 23.
    Vanoverschelde JL, van Dyck M, Gerber B, et al. The role of echocardiography in aortic valve repair. Ann Cardiothorac Surg. 2013;2:65–72.Google Scholar
  24. 24.
    Marom G, Haj-Ali R, Rosenfeld M, Schäfers HJ, Raanani E. Aortic root numeric model: correlation between intraoperative effective height and diastolic coaptation. J Thorac Cardiovasc Surg. 2013;145:303–4.CrossRefGoogle Scholar
  25. 25.
    Marom G, Haj-Ali R, Rosenfeld M, Schäfers HJ, Raanani E. Aortic root numeric model: annulus diameter prediction of effective height and coaptation in post-aortic valve repair. J Thorac Cardiovasc Surg. 2013;145:406–11.CrossRefGoogle Scholar
  26. 26.
    Marom G, Halevi R, Haj-Ali R, Rosenfeld M, Schäfers HJ, Raanani E. Numerical model of the aortic root and valve: optimization of graft size and sinotubular junction to annulus ratio. J Thorac Cardiovasc Surg. 2013;146:1227–31.CrossRefGoogle Scholar
  27. 27.
    le Polain de Waroux JB, Pouleur AC, Goffinet C, et al. Functional anatomy of aortic regurgitation: accuracy, prediction of surgical repairability, and outcome implications of transesophageal echocardiography. Circulation. 2007;116:I264–9.CrossRefGoogle Scholar
  28. 28.
    Thubrikar MJ, Labrosse MR, Zehr KJ, Robicsek F, Gong GG, Fowler BL. Aortic root dilatation may alter the dimensions of the valve leaflets. Eur J Cardiothorac Surg. 2005;28:850–5.CrossRefGoogle Scholar
  29. 29.
    Vollebergh FE, Becker AE. Minor congenital variations of cusp size in tricuspid aortic valves. Possible link with isolated aortic stenosis. Br Heart J. 1977;39:1006–11.CrossRefGoogle Scholar
  30. 30.
    Silver MA, Roberts WC. Detailed anatomy of the normally functioning aortic valve in hearts of normal and increased weight. Am J Cardiol. 1985;55:454–61.CrossRefGoogle Scholar
  31. 31.
    David TE, David CM, Feindel CM, Manlhiot C. Reimplantation of the aortic valve at 20 years. J Thorac Cardiovasc Surg. 2017;153:232–8.CrossRefGoogle Scholar
  32. 32.
    deKerchove L, Mastrobuoni S, Boodhwani M, et al. The role of annular dimension and annuloplasty in tricuspid aortic valve repair. Eur J Cardiothorac Surg. 2016;49:428–37.CrossRefGoogle Scholar
  33. 33.
    Lansac E, Di Centa I, Sleilaty G, et al. Remodeling root repair with an external aortic ring annuloplasty. J Thorac Cardiovasc Surg. 2017;153:1033–42.CrossRefGoogle Scholar
  34. 34.
    Boraita A, Heras ME, Morales F, et al. Reference Values of Aortic Root in Male and Female White Elite Athletes According to Sport. Circ Cardiovasc Imaging. 2016;9:e005292.CrossRefGoogle Scholar
  35. 35.
    Kunihara T, Aicher D, Rodionycheva S, et al. Preoperative aortic root geometry and postoperative cusp configuration primarily determine long-term outcome after valve-preserving aortic root repair. J Thorac Cardiovasc Surg. 2012;143:1389–95.CrossRefGoogle Scholar
  36. 36.
    Kunihara T, Arimura S, Sata F, Giebels C, Schneider U, Schäfers HJ. Aortic annulus does not dilate over time after aortic root remodeling with or without annuloplasty. J Thorac Cardiovasc Surg. 2018;155:885–94.CrossRefGoogle Scholar
  37. 37.
    Aicher D, Kunihara T, Abou Issa O, Brittner B, Gräber S, Schäfers HJ. Valve configuration determines long-term results after repair of the bicuspid aortic valve. Circulation. 2011;123:178–85.CrossRefGoogle Scholar
  38. 38.
    Schneider U, Hofmann C, Aicher D, Takahashi H, Miura Y, Schäfers HJ. Suture Annuloplasty Significantly Improves the Durability of Bicuspid Aortic Valve Repair. Ann Thorac Surg. 2017;103:504–10.CrossRefGoogle Scholar
  39. 39.
    Nawaytou O, Mastrobuoni S, de Kerchove L, Baert J, Boodhwani M, El Khoury G. Deep circumferential annuloplasty as an adjunct to repair regurgitant bicuspid aortic valves with a dilated annulus. J Thorac Cardiovasc Surg. 2018;156:590–7.CrossRefGoogle Scholar
  40. 40.
    Aicher D, Schneider U, Schmied W, Kunihara T, Tochii M, Schäfers HJ. Early results with annular support in reconstruction of the bicuspid aortic valve. J Thorac Cardiovasc Surg. 2013;145:S30–4.CrossRefGoogle Scholar
  41. 41.
    David TE, Feindel CM, Armstrong S, Maganti M. Replacement of the ascending aorta with reduction of the diameter of the sinotubular junction to treat aortic insufficiency in patients with ascending aortic aneurysm. J ThoracCardiovascSurg. 2007;133:414–8.Google Scholar
  42. 42.
    Asano M, Kunihara T, Aicher D, El Beyrouti H, Rodionycheva S, Schäfers HJ. Mid-term results after sinutubular junction remodelling with aortic cusp repair. Eur J Cardiothorac Surg. 2012;42:1010–5.CrossRefGoogle Scholar
  43. 43.
    Komiya T, Shimamoto T, Nonaka M, Matsuo T. Is small cusp size is a limitation for aortic valve repair? Eur J CardiothoracSurg. In press.Google Scholar

Copyright information

© Indian Association of Cardiovascular-Thoracic Surgeons 2019

Authors and Affiliations

  1. 1.Department of Thoracic and Cardiovascular SurgerySaarland University Medical CenterHomburgGermany

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