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You are here: Contents > 2017 > Volume 26 Number 1 January 2017 > AORTIC VALVE DISEASE > Preoperative Computed Tomography Scan Analysis of Interleaflets Triangles to Guide Aortic Root Repair Procedures

Preoperative Computed Tomography Scan Analysis of Interleaflets Triangles to Guide Aortic Root Repair Procedures

Claudia Romagnoni1,5, Andrea Mangini1,2, Monica Contino1, Rubina Rosa1, Sonia Ippolito3, Guido Gelpi1, Carlo Antona1,4

1Cardiovascular Surgery Department, ASST Fatebenefratelli-Sacco, Milan, Italy
2DEIB Department Politecnico di Milano, Milan, Italy
3Diagnostic Radiology Department, ASST Fatebenefratelli-Sacco, Milan,Italy
4Università degli Studi di Milano, Milan, Italy
5Electronic correspondence: clau.romagnoni@hotmail.it

Background and aim of the study: Stabilization of the ventriculo-aortic junction (VAJ) is gaining increasing interest in the context of aortic valve repair, since its dilation is a well-recognized risk factor for long-term repair failure. Interleaflets triangles are key elements of the VAJ, but cannot be completely visualized using echocardiography. A three-dimensional (3D) reconstruction of electrocardiogram-triggered computed tomography (CT) scan images allows an analysis of the real dimensions and anatomic characteristics of the subcommissural triangles.

Methods: A method was developed to visualize the interleaflets triangle at the CT-scan based on multiplanar post-processing reconstructions. Attention was focused on the triangles’ apical angle evaluation. The data obtained with CT-scan reconstructions were compared with those collected in a previous post-mortem study to validate this measurement method.

Results: In the CT-scan group the angles between the left

and right coronary sinuses, and the right non-coronary and left non-coronary sinuses were 46.23 ± 7.79°, 47.38 ± 6.97°, 45° [range: 42.75- 50.75°], respectively, and in the post-mortem group were 45.44 ± 12.39°, 48.31 ± 1218°, 50.25 ± 7.29°. No statistically significant differences between the two groups were identified (p = 0.84, 0.81, and 0.23).

Conclusion: Based on experience acquired in the operating room, the acute-angle subcommissural triangles were considered normal, the equilateral triangles mildly dilated, and the obtuse triangles severely dilated. According to this classification, different reparative approaches were selected. A CTscan 3D reconstruction method, as validated by the present data, allows a preoperative evaluation of the triangles and VAJ in order to best plan a surgical reparative approach tailored to a single patient.

The Journal of Heart Valve Disease 2017;26:12-17

Preoperative Computed Tomography Scan Analysis of Interleaflets Triangles to Guide Aortic Root Repair Procedures

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