Irace Francesco Giosuè, Chirichilli Ilaria, Salica Andrea, D'Aleo Salvatore, Guerrieri Wolf Lorenzo, Garufi Luigi, De Paulis Ruggero
Department of Cardiac Surgery, European Hospital, Rome, Italy; Department of General and Specialized Surgery "Paride Stefanini," Sapienza University, Rome, Italy.
Department of Cardiac Surgery, European Hospital, Rome, Italy; Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, Rome, Italy.
J Thorac Cardiovasc Surg. 2023 Apr;165(4):1335-1342.e2. doi: 10.1016/j.jtcvs.2021.03.115. Epub 2021 Apr 16.
During the last decade, special concerns have been raised about the anatomic relationships among the sinotubular junction, ventricular-aortic junction, and virtual basal ring to improve the results of root reconstruction. The aim of this study is to evaluate the in vivo anatomy of the aortic root after reimplantation with the Valsalva graft and the anatomic relationship between its components.
We analyzed 10 consecutive patients with tricuspid aortic valves who underwent reimplantation with the Valsalva graft between September and December 2019. Surgical clips were applied as markers at the level of proximal annular knots and at the distal reimplanted commissures on the neo-sinotubular junction. Electrocardiogram-gated computed tomography scan of the aortic root was performed. Coordinates of the markers were exported on a 3-dimensional modeling software, and the distances between the virtual basal ring and the Dacron graft basal landmarks were measured.
The mean heights of Dacron graft basal landmarks from virtual basal ring were right-left commissure 7.1 ± 5.1 mm; right sinus 4.7 ± 4.1 mm; right-noncoronary commissure 2.8 ± 2.2 mm; noncoronary sinus 1.4 ± 1.6 mm; left-noncoronary commissure 2.2 ± 2.3 mm; and left sinus 2.0 ± 0.9 mm. The mean planar distances of basal Dacron graft landmarks from virtual basal ring (thickness) were right-left commissure 5.3 ± 3.1 mm; right sinus 2.8 ± 1.4 mm; right-noncoronary commissure 2.2 ± 1.5 mm; noncoronary sinus 1.5 ± 1.5 mm; left-noncoronary commissure 1.3 ± 1.0 mm; and left sinus 3.4 ± 2.5 mm.
After reimplantation, despite a complete dissection of the root, slight asymmetry of graft proximal seating exists. The inner annuloplasty is on the virtual basal ring, and the proximal edge of the Dacron graft is on the ventricular-aortic junction at a slightly different thickness and height along the annular circumference. At the level of the right sinus and left/right commissure, the Dacron graft is higher than the virtual basal ring and the relative wall thickness is increased. The annular stabilization is unaffected.
在过去十年中，人们对窦管交界、心室 - 主动脉交界和虚拟基环之间的解剖关系给予了特别关注，以改善根部重建的效果。本研究的目的是评估用瓦氏窦移植物再植入后主动脉根部的体内解剖结构及其各组成部分之间的解剖关系。
我们分析了2019年9月至12月期间连续10例接受瓦氏窦移植物再植入的三尖瓣主动脉瓣患者。在近端环形结水平和新窦管交界的远端再植入连合处应用手术夹作为标记。对主动脉根部进行心电图门控计算机断层扫描。将标记的坐标导出到三维建模软件上，并测量虚拟基环与涤纶移植物基底标志之间的距离。
涤纶移植物基底标志到虚拟基环的平均高度分别为：左右连合处7.1±5.1mm；右窦4.7±4.1mm；右 - 无冠连合处2.8±2.2mm；无冠窦1.4±1.6mm；左 - 无冠连合处2.2±2.3mm；左窦2.0±0.9mm。涤纶移植物基底标志到虚拟基环的平均平面距离（厚度）分别为：左右连合处5.3±3.1mm；右窦2.8±1.4mm；右 - 无冠连合处2.2±1.5mm；无冠窦1.5±1.5mm；左 - 无冠连合处1.3±1.0mm；左窦3.4±2.5mm。
再植入后，尽管对根部进行了完全解剖，但移植物近端着床仍存在轻微不对称。内部瓣环成形术位于虚拟基环上，涤纶移植物的近端边缘位于心室 - 主动脉交界处，沿瓣环圆周的厚度和高度略有不同。在右窦和左/右连合处水平，涤纶移植物高于虚拟基环，相对壁厚增加。瓣环稳定性未受影响。
