Marom Gil, Weltert Luca Paolo, Raanani Ehud, Chirirchilli Ilaria, Giebels Christian, Irace Francesco Giosuè, De Paulis Ruggero, Schäfers Hans-Joachim
School of Mechanical Engineering, Tel Aviv University, Tel Aviv, Israel.
Department of Cardiac Surgery, European Hospital, Rome, Italy.
Interdiscip Cardiovasc Thorac Surg. 2024 Feb 2;38(2). doi: 10.1093/icvts/ivae024.
Aortic valve repair requires the creation of a normal geometry of cusps and aortic root. Of the different dimensions, geometric cusp height is the most difficult to change while annular and sinotubular dimensions can be easily modified. The objective of this study was to investigate, by computer simulation, ideal combinations of annular and sinotubular junction size for a given geometric height.
Based on a literature review of anatomical data, a computational biomechanics model was generated for a tricuspid aortic valve. We aimed to determine the ideal relationships for the root dimensions, keeping geometric height constant and creating different combinations of the annular and sinotubular junction dimensions. Using this model, 125 virtual anatomies were created, with 25 different combinations of annulus and sinotubular junction. Effective height, coaptation height and mechanical cusp stress were calculated with the valves in closed configuration.
Generally, within the analysed range of geometric heights, changes to the annular diameter yielded a stronger impact than sinotubular junction diameter changes for optimal valve configuration. The best results were obtained with the sinotubular junction being 2-4 mm larger than the annulus, leading to higher effective height, normal coaptation height and lower stress. Within the range tested, stenosis did not occur due to annular reduction.
In tricuspid aortic valves, the geometric height can be used to predict ideal post-repair annular and sinotubular junction dimensions for optimal valve configuration. Such an ideal configuration is associated with reduced cusp stress.
主动脉瓣修复需要重塑瓣叶和主动脉根部的正常几何形态。在不同维度中，瓣叶几何高度最难改变，而瓣环和窦管交界尺寸则较易调整。本研究的目的是通过计算机模拟，探究给定几何高度下瓣环和窦管交界尺寸的理想组合。
基于对解剖学数据的文献综述，构建了一个三尖瓣主动脉瓣的计算生物力学模型。我们旨在确定根部尺寸的理想关系，保持几何高度不变，并创建瓣环和窦管交界尺寸的不同组合。使用该模型，创建了125个虚拟解剖结构，其中瓣环和窦管交界有25种不同组合。在瓣膜处于关闭状态时计算有效高度、贴合高度和瓣叶机械应力。
一般来说，在分析的几何高度范围内，对于优化瓣膜构型，瓣环直径的变化比窦管交界直径的变化产生的影响更大。当窦管交界比瓣环大2 - 4毫米时，可获得最佳结果，此时有效高度更高、贴合高度正常且应力更低。在测试范围内，未因瓣环缩小而发生狭窄。
在三尖瓣主动脉瓣中，几何高度可用于预测修复后瓣环和窦管交界的理想尺寸，以实现最佳瓣膜构型。这种理想构型与瓣叶应力降低相关。
