Aortic root geometry: Pattern of differences between leaflets and sinuses of Valsalva

Background and aims of the study: Growing interest in aortic root replaceme nt with the use of stentless auto-, homo- and xenografts, and new developme nts in aortic valve conservation demand a deeper understanding of the norma l aortic root anatomy. Methods: Ten cryopreserved human aortic roots were pressurized, fixed and m easured directly (leaflet free edge and attachment) and using three-dimensi onal computed tomography imaging software (sinus of Valsalva height and vol ume). Results: The mean of the measurements of all four parameters yielded a patt ern in which the non-coronary sinus (N) structures had the greatest dimensi ons followed by the right (R) and then the left (L), Nonparametric ANOVA on each of these parameters also showed significant differences among the sin uses yielding a pattern of N>R>L. This pattern determined an angle of tilt between the plane at the base (annulus) and. the plane intersecting the sin otubular junction with a mean value of 11 degrees. Linear regression indica ted that this angle did not depend on the size of the base (annulus). Conclusions: The data showed a geometric pattern of the aortic root, with t he structures of the non-coronary sinus being the largest followed by the r ight and then the left. The possible hemodynamic relevance and surgical imp lications of these findings need to be explored.