The Ross Procedure: New Insights Into the Surgical Anatomy

Pulmonary Autograft Coronary-Cameral Fistula Leading to LVOT Pseudoaneurysm Post Ross Procedure

We report the case of a presumed coronary-cameral fistula arising directly below the commissures of the noncoronary cusp (NCC) and left coronary cusp (LCC) of the pulmonary autograft, leading to left ventricular outflow tract pseudoaneurysm and late tamponade post Ross procedure.

The clinical anatomy of the coronary arteries

There are a manifold number of variations and anomalies of the origin and course of coronary arteries described in the literature. The incidence of such variations in the general population is reported to range between 0.3 and 1.6 %. Although uncommon, they may be benign or produce symptoms ranging from mild dyspnea to sudden cardiac death, and have been associated with an increased risk of accelerated atherosclerosis and perfusion defects. Thus, in order to effectively utilize the increasing number of therapeutic options available for treating coronary artery diseases, an appreciation of the likely normal and variable arrangements of the coronary arteries is essential. This review will describe the normal anatomy of the coronary arteries as well as the common variations with potential clinical effects.

The left ventricular outflow in hypertrophic cardiomyopathy: from structure to function

Left ventricular outflow tract obstruction (LVOTO) is one of the defining features of hypertrophic cardiomyopathy (HCM) and one of the main determinants of prognosis. Although the importance of obstruction was recognized since the original description by Teare and Brock, its exact cause and methods for its relief are still being hotly debated. We believe that a rational approach to solving these issues depends on thorough understanding of the specific structure and functions of the left ventricular outflow tract (LVOT) in health and disease. There is now compelling evidence that the LVOT performs a series of vital sophisticated functions which are mediated by the design characteristics, structure, and biological properties of its component parts and that dysregulation of one or more of these functions results in obstruction and other abnormalities. We here review the integrated functions of the LVOT, its structural and functional relationships, with particular reference to its component parts (the major players) and their role in HCM. This knowledge is essential to evolve tailored restorative techniques for treating HCM.

The normal and abnormal anatomy of the coronary arteries

Beneficial therapeutic options are increasingly available for coronary arterial disease. To take full advantage of these options, those performing the interventions require a thorough knowledge of the normal arrangement, and likely anatomic variations, of the coronary arterial system. A comprehensive appreciation of the architecture of the coronary arterial system, therefore, is crucial to optimal cardiac care. Simple attention to potential variations in the origin and course of the major coronary arteries can greatly enhance clinical outcomes. The objective of this review, therefore, is to describe the normal anatomical distribution of the coronary arteries in the human heart, and to list the most common arterial variations.

Gender-specific differences in aortic sinus curvature during aging: an anatomical and computational study

INTRODUCTION

Our goal was to investigate the potential impact of aortic sinus wall curvature on the risk for type A aortic dissection.

METHODS

We measured the curvature and carried out histological tests of the aortic noncoronary sinus in 46 patients who did not die from cardiac disease. Based on observed curvature values, we investigated the mechanical stress in the aortic root using finite element analysis.

RESULTS

Sinus curvature was found to experience a more than fourfold increase with age in males and reached the higher, age-independent values measured in females by age 65. The histological tests revealed that degenerative alterations did not significantly increase with aging in either gender, although fibrosis did in older women. Finite element analysis illustrated that the risk for a circumferential tear to occur was smallest when sinus curvature was highest.

CONCLUSIONS

We established significant gender-specific disparities in the aortic root during aging: while aortic sinus curvature was high in females throughout their lives, it experienced a more than fourfold increase in the lifetime of males, matching values in females only by age 65. Our mechanical analyses confirmed the overall potential protective role of higher sinus wall curvature with respect to type A aortic dissection, and geometry alone could not account for the known gender difference in aortic dissection prevalence.