Federspiel Jan Michael, Abeln Karen B, Ramsthaler Frank, Tschernig Thomas, Schmidt Peter H
Institute for Legal Medicine, Faculty of Medicine, Saarland University, Campus Homburg, Building 49.1, Kirrberger Straße 100, 66421, Homburg/Saar, Germany.
Department of Cardiac Surgery, Saarland University Medical Center, Homburg/Saar, Germany.
Int J Legal Med. 2025 May;139(3):1113-1130. doi: 10.1007/s00414-025-03409-1. Epub 2025 Jan 21.
Aortic regurgitation is a common valve disease and can be caused by delineated findings such as fenestrations or hardly discernible alterations of the aortic root geometry. Therefore, aortic regurgitation can be a challenging diagnosis during an autopsy. Cardiac surgeons, however, are confronted with comparable problems during surgery and have developed a refined knowledge of the anatomy of the aortic root including its geometry. Transferring this knowledge from the operating room to the dissection would further complement the panel of postmortem diagnostic tools. To foster translation of the clinical anatomy, the present study assessed the impact of postmortem peculiarities (i.e. myocardial rigor mortis, putrefaction) that might influence aortic root geometry. The aortic root geometry was described by aortic perimeters (basal, sinus, sino-tubular junction, and ascending aorta), effective height (distance from the cusp's free margin to its nadir), geometric height (cusp height), commissural height (distance from the base of an interleaflet triangle to the end of a commissure), and length of the ascending aorta. Data from 140 cases were analyzed (linear regression, comparative testing). Myocardial rigor mortis was associated with smaller basal rings. Weak positive correlations between the duration of the postmortem interval and aortic root dimensions were observed. In summary, postmortem peculiarities, especially the myocardial cadaveric rigidity, influence postmortem aortic root geometry. Despite these circumstances, the current study demonstrates that aortic root geometric assessment, including effective height, is feasible in a postmortem setting. Further studies are needed to elaborate on aortic root geometry as a diagnostic tool in a necropsy setting.
主动脉瓣反流是一种常见的瓣膜疾病，可由诸如开窗或主动脉根部几何形状难以察觉的改变等明确的发现引起。因此，在尸检过程中，主动脉瓣反流可能是一个具有挑战性的诊断。然而，心脏外科医生在手术过程中也面临类似的问题，并对主动脉根部的解剖结构，包括其几何形状，有了更深入的了解。将这些知识从手术室应用到解剖中，将进一步完善尸检诊断工具。为了促进临床解剖学的转化，本研究评估了可能影响主动脉根部几何形状的尸检特殊情况（即心肌尸僵、腐败）。通过主动脉周长（基部、窦部、窦管交界部和升主动脉）、有效高度（从瓣叶游离缘到其最低点的距离）、几何高度（瓣叶高度）、联合高度（从瓣叶间三角形基部到联合末端的距离）和升主动脉长度来描述主动脉根部的几何形状。分析了140例病例的数据（线性回归、对比测试）。心肌尸僵与较小的基部环有关。观察到尸检间隔时间与主动脉根部尺寸之间存在弱正相关。总之，尸检特殊情况，尤其是心肌尸僵，会影响尸检时的主动脉根部几何形状。尽管存在这些情况，但本研究表明，在尸检环境中，包括有效高度在内的主动脉根部几何形状评估是可行的。需要进一步的研究来详细阐述主动脉根部几何形状作为尸检诊断工具的作用。
