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Eur J Cardiothorac Surg 2005;28:850-855
© 2005 Elsevier Science NL

Aortic root dilatation may alter the dimensions of the valve leaflets

^a Heineman Medical Research Laboratory, Department of Thoracic and Cardiovascular Surgery, Carolinas Medical Center, Charlotte, NC, USA
^b Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA

Received 22 June 2005; received in revised form 20 August 2005; accepted 18 September 2005.

^_* Corresponding author at: Department of Mechanical Engineering, University of Ottawa, Ottawa, Ont., Canada K1N 6N5. Tel.: +1 613 562 5800x6284; fax: +1 613 562 5177. (Email: labrosse{at}eng.uottawa.ca).

Objective: Valve-sparing surgery can be used in patients with dilated aortic roots and aortic insufficiency (AI) but has not become a common practice, in part because the spared valve may be incompetent. Our goal was to study how the dimensions of the aortic root and leaflets have changed in such patients. Methods: Fourteen patients with dilated aortic root and AI were examined by transesophageal echocardiography. The annulus diameter, sinotubular junction (STJ) diameter, sinus height, leaflet free-edge length, and leaflet height were measured. Correlations among these dimensions and with the AI grades were explored. Measurements were also made in 19 normal human aortic valves from silicone molds. Results: There was no evident change in the average diameter of the annulus between the normal valves and those in the dilated aortic roots. The STJ diameter was obviously increased in the dilated aortic roots; the aortic sinuses also appeared to be taller and the leaflets larger than normal. The leaflet free-edge length, the leaflet height, and the sinus height were found to increase with the dilated STJ diameter. The degree of AI was not found to correlate well with any of the dimensions measured. Conclusions: The dimensions of the leaflets may change parallel to aortic root dilatation with AI. Therefore, during valve sparing, it may be necessary to correct both the dilatation of the root and the leaflet free-edge length to achieve a competent valve.

Key Words: Aortic valve • Aortic root • Leaflets • Dimensions • Aneurysm • Insufficiency

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