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Koerner TS, Cunningham T, Marshall ME, Talley LS, Childress M, Kharouf RM, Li W, Salazar JD, Corno AF. Aortic valve leaflets are asymmetric and correlated with the origin of coronary arteries. Transl Pediatr 2023; 12:2164-2178. [PMID: 38197112 PMCID: PMC10772836 DOI: 10.21037/tp-23-369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 11/16/2023] [Indexed: 01/11/2024] Open
Abstract
Background Asymmetry of the aortic valve leaflets has been known since Leonardo Da Vinci, but the relationship between size and shape and origin of the coronary arteries has never been examined. Our aim was to evaluate this anatomy in a population of pediatric patients using a cross-sectional study design. Methods Consecutive pediatric patients with trans-esophageal echocardiography (TEE), with or without trans-thoracic echocardiography (TTE), were included in our study. Exclusion criteria: (I) bicuspid aortic valve; (II) aortic valve stenosis; (III) hypoplasia of aortic valve annulus, or aortic root; (IV) truncal valve; (V) coronary artery atresia; (VI) previous surgery on aortic valve and/or coronary arteries. In pre-operative TTE and intra-operative TEE inter-commissural distance and length of aortic valve leaflets were measured in short axis view in the isovolumic phase of systole. Echocardiography investigations, anonymized and randomly coded, were independently reviewed by at least two readers. Echocardiography, angiography, cardiac computed tomography (CT) scan and magnetic resonance imaging (MRI), and operative notes were reviewed to identify origin of coronary arteries. Results Two hundred sixty-one pediatric patients were identified, 93 excluded per our criteria, leaving 168 patients, age 2.6±4.3 years, weight 12.87±17.34 kg, 128 (76%) with normal and 40 (24%) with abnormal coronary arteries. In TTE and TEE measurements the non-coronary leaflet had larger area (P<0.001), while the right and left had equal areas, but different shape, with the left leaflet longer (P<0.001) and narrower (P=0.005) than the right. With the major source of blood flow from the right coronary sinus, the non-coronary leaflet was still the longest. However, there was no statically significant difference between the size and shape previously observed between the right and left leaflets. Conclusions Our study showed asymmetry of size and shape among aortic valve leaflets, and a relationship with coronary artery origin. The complex aortic root anatomy must be approximated to optimize function of any surgical repair. These findings also may prove useful in the pre-operative definition of coronary artery anatomy and in the recognition of coronary artery anomalies.
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Affiliation(s)
- Taylor S. Koerner
- Children’s Heart Institute, Memorial Hermann Children’s Hospital, UTHealth Science Center in Houston, McGovern Medical School, Houston, TX, USA
| | - Thomas Cunningham
- Children’s Heart Institute, Memorial Hermann Children’s Hospital, UTHealth Science Center in Houston, McGovern Medical School, Houston, TX, USA
| | - Mayme E. Marshall
- Children’s Heart Institute, Memorial Hermann Children’s Hospital, UTHealth Science Center in Houston, McGovern Medical School, Houston, TX, USA
| | - Lauren S. Talley
- Children’s Heart Institute, Memorial Hermann Children’s Hospital, UTHealth Science Center in Houston, McGovern Medical School, Houston, TX, USA
| | - Megan Childress
- Children’s Heart Institute, Memorial Hermann Children’s Hospital, UTHealth Science Center in Houston, McGovern Medical School, Houston, TX, USA
| | - Rami M. Kharouf
- Children’s Heart Institute, Memorial Hermann Children’s Hospital, UTHealth Science Center in Houston, McGovern Medical School, Houston, TX, USA
| | - Wen Li
- Division of Clinical and Translational Sciences, Department of Internal Medicine, Biostatistics/Epidemiology/Research Design Component, Center for Clinical and Translational Sciences, UTHealth Science Center in Houston, McGovern Medical School, Houston, TX, USA
| | - Jorge D. Salazar
- Children’s Heart Institute, Memorial Hermann Children’s Hospital, UTHealth Science Center in Houston, McGovern Medical School, Houston, TX, USA
| | - Antonio F. Corno
- School of Engineering, University of Leicester, Leicester, England, UK
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Shao Z, Tao T, Xu H, Chen C, Lee I, Chung S, Dong Z, Li W, Ma L, Bai H, Chen Q. Recent progress in biomaterials for heart valve replacement: Structure, function, and biomimetic design. VIEW 2021. [DOI: 10.1002/viw.20200142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Ziyu Shao
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine & Clinical Research Center for Oral Diseases of Zhejiang Province Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University Hangzhou 310006 China
- State Key Laboratory of Chemical Engineering College of Chemical and Biological Engineering Zhejiang University Hangzhou China
| | - Tingting Tao
- Department of Cardiovascular Surgery The First Affiliated Hospital Zhejiang University School of Medicine Hangzhou Zhejiang Province China
| | - Hongfei Xu
- Department of Cardiovascular Surgery The First Affiliated Hospital Zhejiang University School of Medicine Hangzhou Zhejiang Province China
| | - Cen Chen
- College of Life Sciences and Medicine Zhejiang Sci‐Tech University Hangzhou China
| | - In‐Seop Lee
- College of Life Sciences and Medicine Zhejiang Sci‐Tech University Hangzhou China
- Institute of Natural Sciences Yonsei University Seoul Republic of Korea
| | - Sungmin Chung
- Biomaterials R&D Center GENOSS Co., Ltd. Suwon‐si Republic of Korea
| | - Zhihui Dong
- State Key Laboratory of Chemical Engineering College of Chemical and Biological Engineering Zhejiang University Hangzhou China
| | - Weidong Li
- Department of Cardiovascular Surgery The First Affiliated Hospital Zhejiang University School of Medicine Hangzhou Zhejiang Province China
| | - Liang Ma
- Department of Cardiovascular Surgery The First Affiliated Hospital Zhejiang University School of Medicine Hangzhou Zhejiang Province China
| | - Hao Bai
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine & Clinical Research Center for Oral Diseases of Zhejiang Province Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University Hangzhou 310006 China
- State Key Laboratory of Chemical Engineering College of Chemical and Biological Engineering Zhejiang University Hangzhou China
| | - Qianming Chen
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine & Clinical Research Center for Oral Diseases of Zhejiang Province Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University Hangzhou 310006 China
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Abstract
PURPOSE OF REVIEW Until the year 2000, the publications concerning aortic valve sparing (AVS) did not exceed 20 articles; in the following years almost 300 publications have appeared. Over 35 years from the introduction of valve sparing techniques and 500 years after the death of Leonardo da Vinci, this review highlights the significant steps in modern imaging techniques and the excellent clinical results in the field of reconstructive aortic root surgery. RECENT FINDINGS AVS operations underwent significant modifications over the last few years making it reproducible with satisfactory outcomes. The extraordinary potential of imaging opens new boundless horizons in the perspective of an increasingly patient-tailored surgical planning. The basic surgical concepts include the preservation and resuspension of the aortic valve in a near-normal environment (with the creation of functionally suited neo-aortic sinuses) and the re-establishment of a normal relationship of the aortic root components. SUMMARY Today is possible to perform a reimplantation procedure with the creation of neo-sinuses or a remodeling procedure with the addition of annular support. Both procedures can now guarantee an anatomical root reconstruction and an increased long-term durability. AVS operations have become established alternatives to Bentall procedures for patients with aortic root pathology, especially in young patients.
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Surgical treatment of mitral regurgitation. Curr Opin Cardiol 2020; 35:491-499. [PMID: 32740446 DOI: 10.1097/hco.0000000000000772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Mitral repair is the best treatment for degenerative mitral regurgitation. Many patients are referred too late for optimal outcomes. The US repair vs. replacement rate is only 60-80%, at a time when the inferiority of replacement has been established. Therefore, widely used traditional techniques of repair are being reappraised. RECENT FINDINGS Identification of risk factors predictive of poor early and late outcome have improved timing for surgical referral. Composite risk scores have been developed. Novel echocardiographic, cardiac MRI, and molecular level risk factors could improve timing. Analysis of factors contributing to low repair rates is also of critical importance. The role of institutional and surgeon volumes have been identified. More detailed data on the importance of dynamic function of the mitral valve have led to improved repair techniques such as intraoperative simulation of end diastole and early systole, use of expanded polytetrafluoroethylene neochords instead of leaflet resection, and dynamic instead of rigid annuloplasty. SUMMARY Our perception of mitral regurgitation has changed from a seemingly simple condition to one of considerable complexity at multiple levels. National guidelines should be studied and followed.
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