He Zheng-Fu, Zhang Wei-Ming, Lutter George, Quaden Rene, Cremer Jochen, Cai Xiu-Jun
1 Department of Cardiothoracic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China ; 2 Department of Cardiovascular Surgery, School of Medicine, University Of Kiel, Kiel, Germany ; 3 Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China.
J Thorac Dis. 2014 Dec;6(12):1772-7. doi: 10.3978/j.issn.2072-1439.2014.12.19.
Transcatheter aortic valve implantation (TAVI) has been developed recently for patients with high morbidities and who are believed to be not tolerate standard surgical aortic valve replacement. Nevertheless, the TAVI is associated with complications such as potential obstruction of coronary ostia, mitral valve insufficiency, and stent migration although it seems promising. Impairment of the coronary blood flow after TAVI is catastrophic and it was believed to be associated with the close position of the coronary orifice and the aortic leaflets and valve stent. However, few data was available as to the anatomic relationship between valve stent and aortic root anatomic structures including the coronary arterial ostia, aortic leaflets.
The aortic roots were observed in 40 hearts specimens. The width of aortic leaflet, height of aortic sinus annulus to the sinutubular junction (STJ), distance between aortic sinus annulus to its corresponding coronary ostia, and coronary arterial ostia to its corresponding STJ level were measured. Moreover, the relationships of valve stent, aortic leaflets and coronary ostia before/post stent implantation and after the open of aorta were evaluated respectively.
Approximate three quarters of the coronary ostia were located below the STJ level. The mean distances from left, right and posterior aortic sinus annulus to the related STJ level was comparable, which was 18.5±2.7, 18.9±2.6, 18.7±2.6 mm, respectively. Meanwhile, the height of left and right aortic sinus annulus to its corresponding coronary ostia was 16.6±2.8 and 17.2±3.1 mm for left and right side respectively.
Most of the coronary ostia were located below the STJ level and could be covered by the leaflets. This highlights the need of modified stents to prevent occlusion of coronary flow after TAVI.
经导管主动脉瓣植入术（TAVI）是最近为高发病且被认为无法耐受标准外科主动脉瓣置换术的患者开发的。然而，尽管TAVI看起来很有前景，但它与诸如冠状动脉口潜在阻塞、二尖瓣关闭不全和支架移位等并发症相关。TAVI后冠状动脉血流受损是灾难性的，并且据信这与冠状动脉口、主动脉瓣叶和瓣膜支架的紧密位置有关。然而，关于瓣膜支架与主动脉根部解剖结构（包括冠状动脉口、主动脉瓣叶）之间的解剖关系的数据很少。
观察40个心脏标本的主动脉根部。测量主动脉瓣叶宽度、主动脉窦环至窦管交界（STJ）的高度、主动脉窦环与其相应冠状动脉口之间的距离以及冠状动脉口与其相应STJ水平之间的距离。此外，分别评估支架植入前后和主动脉开放后瓣膜支架、主动脉瓣叶和冠状动脉口之间的关系。
大约四分之三的冠状动脉口位于STJ水平以下。左、右和后主动脉窦环至相关STJ水平的平均距离相当，分别为18.5±2.7、18.9±2.6、18.7±2.6毫米。同时，左、右主动脉窦环至其相应冠状动脉口的高度，左侧为16.6±2.8毫米，右侧为17.2±3.1毫米。
大多数冠状动脉口位于STJ水平以下，可被瓣叶覆盖。这突出了需要改良支架以防止TAVI后冠状动脉血流阻塞。
