Department of Cardiovascular Surgery Osaka University Graduate School of Medicine Osaka Japan.
Department of Integrated Medicine, Institute of Biomedical Statistics, Osaka University Graduate School of Medicine Osaka Japan.
J Am Heart Assoc. 2024 Aug 20;13(16):e035826. doi: 10.1161/JAHA.124.035826. Epub 2024 Aug 19.
Variations in the aortomitral positional anatomy, including aortic root rotation appear to be related to variations in the location of the conduction system, including the bundle of His. However, little is known about their clinical significance.
This study included 147 patients with normal ECGs who underwent mitral valve surgery. The aortomitral anatomy was classified using preoperative 3-dimensional transesophageal echocardiography, and postoperative conduction disorders, including atrioventricular block and bundle branch block, were analyzed. Variations classified as aortomitral appearance were designated as having a center appearance (85.7%, n=126/147) or lateral appearance (14.3%, n=21/147) on the basis of whether the aortic root was located at the center or was shifted to the left fibrous trigone side. Subsequently, those with a center appearance, aortic root rotation was classified as having a center rotation (83.3% [n=105/126]), in which the commissure of the left and noncoronary aortic leaflet was located at the center, lateral rotation (14.3% [n=18/126]), rotated to the left trigone side, or medial rotation (2.4% [n=3/126]), rotated to the right. The incidence of 3-month persistent new-onset conduction disorder was higher in the lateral appearance than the center appearance group (21.1% versus 5.0%; =0.031) and higher in the lateral rotation than in the center or medial rotation groups (29.4% versus 1.0% versus 0.0%, respectively; <0.001).
Aortomitral variations can be classified using 3-dimensional transesophageal echocardiography. Lateral appearance and lateral rotation are risk factors for conduction disorders in mitral valve surgery.
主动脉瓣二尖瓣位置解剖结构的变化，包括主动脉根部旋转，似乎与传导系统位置的变化有关，包括希氏束。然而，它们的临床意义知之甚少。
本研究纳入了 147 例心电图正常的行二尖瓣手术患者。术前通过 3 维经食管超声心动图对主动脉瓣二尖瓣解剖结构进行分类，并分析术后传导障碍，包括房室传导阻滞和束支传导阻滞。根据主动脉根部位于中心还是偏向左侧纤维三角侧，将分类为主动脉瓣二尖瓣外观的变异分为中心外观（85.7%，n=126/147）或外侧外观（14.3%，n=21/147）。随后，对于中心外观，主动脉根部旋转分为中心旋转（83.3%[n=105/126]），即左、无冠瓣的交界位于中心；外侧旋转（14.3%[n=18/126]），旋转至左侧纤维三角侧；或内侧旋转（2.4%[n=3/126]），旋转至右侧。外侧外观组 3 个月新发持续性传导障碍的发生率高于中心外观组（21.1%比 5.0%；=0.031），外侧旋转组高于中心旋转或内侧旋转组（29.4%比 1.0%比 0.0%，分别；<0.001）。
可以通过 3 维经食管超声心动图对主动脉瓣二尖瓣变异进行分类。外侧外观和外侧旋转是二尖瓣手术中传导障碍的危险因素。
