Claudia Romagnoni1,5, Andrea Mangini1,2, Monica Contino1, Rubina Rosa1, Sonia Ippolito3, Guido Gelpi1, Carlo Antona1,41Cardiovascular 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: firstname.lastname@example.org
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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