Jelenc Matija, Jelenc Blaž, Habjan Sara, Abeln Karen B, Fries Peter, Michelena Hector I, Schäfers Hans Joachim
Department of Cardiovascular Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Faculty of Mathematics and Physics, University of Ljubljana, Ljubljana, Slovenia.
Interdiscip Cardiovasc Thorac Surg. 2024 Dec 3;39(6). doi: 10.1093/icvts/ivae206.
The Ross procedure is currently receiving renewed interest. Its function and durability depend on preservation of pulmonary valve anatomy; limited data exist on normal pulmonary valve geometry. The objective was to compare aortic and pulmonary root and cusp dimensions in adults with normal tricuspid aortic and pulmonary valves.
We reviewed 507 coronary computed tomography studies, selecting those with adequate visibility of both pulmonary and aortic roots for further analysis. Diastolic aortic and pulmonary root and cusp dimensions were measured. Root dimensions at different phases of the cardiac cycle were measured in 3 patients.
We analysed studies of 50 patients with the mean age of 54 years [standard deviation (SD): 16]. In end-diastole, pulmonary root had a smaller sinutubular to basal ring ratio than the aortic root [0.82 (SD: 0.09) vs 1.14 (SD: 0.12), P < 0.001]. Aortic and pulmonary cusps had similar dimensions; however, pulmonary cusp effective height was lower [5.9 mm (SD: 1.6) vs 8.4 mm (SD: 1.2), P < 0.001]. Pulmonary basal ring perimeter was largest at end-diastole and smallest at end-systole, with the relative difference of 23.5% (SD: 2.7).
The pulmonary root has a similar cusp size compared to the aortic root, but a different shape, resulting in a lower pulmonary cusp effective height. The perimeter of the pulmonary basal ring changes during the cardiac cycle. These findings suggest that stabilizing the autograft to normal aortic, rather than pulmonary, root dimensions should result in normal autograft cusp configuration. Computed tomography angiography could become a tool for personalized planning of the Ross procedure.
目前，罗斯手术再次受到关注。其功能和耐久性取决于肺动脉瓣解剖结构的保留；关于正常肺动脉瓣几何形状的数据有限。目的是比较具有正常三尖瓣主动脉瓣和肺动脉瓣的成年人的主动脉根部和肺动脉根部以及瓣叶尺寸。
我们回顾了507例冠状动脉计算机断层扫描研究，选择那些肺动脉根部和主动脉根部均有足够可视性的研究进行进一步分析。测量舒张期主动脉根部、肺动脉根部和瓣叶尺寸。在3例患者中测量心动周期不同阶段的根部尺寸。
我们分析了50例患者的研究，平均年龄54岁[标准差（SD）：16]。在舒张末期，肺动脉根部的窦管交界与基环比值小于主动脉根部[0.82（SD：0.09）对1.14（SD：0.12），P＜0.001]。主动脉瓣叶和肺动脉瓣叶尺寸相似；然而，肺动脉瓣叶有效高度较低[5.9mm（SD：1.6）对8.4mm（SD：1.2），P＜0.001]。肺动脉基环周长在舒张末期最大，在收缩末期最小，相对差异为23.5%（SD：2.7）。
与主动脉根部相比，肺动脉根部的瓣叶大小相似，但形状不同，导致肺动脉瓣叶有效高度较低。肺动脉基环周长在心动周期中发生变化。这些发现表明，将自体移植物稳定到正常主动脉根部尺寸而非肺动脉根部尺寸应能使自体移植物瓣叶构型正常。计算机断层扫描血管造影术可能成为罗斯手术个性化规划的工具。
