Noncoronary Sinus Research Articles

The height of the sinuses of Valsalva depending on anthropometric data among Ukrainian population

Sinuses of Valsalva height is an important parameter in planning cardiac surgery, percutaneous coronary intervention and transcatheter aortic valve implantation (TAVI). The aim of the study is to analyze the height of the sinuses of Valsalva depending on height, weight, body mass index, body surface area, and sex using computed tomography angiography images in Ukrainian population. 59 chest computed tomography angiography examination for non-cardiac reasons were retrospectively evaluated. Data were collected from Ukrainian citizen. The height of the Sinuses of Valsalva was measured as the distance between aortic annulus and sinotubular junction. All three sinuses of Valsalva height were higher in men than in women (p<0.001). In men, three Sinuses of Valsalva had a correlation with height and body surface area (BSA) (р<0.05). In women, a correlation has been confirmed only between anthropometric measurements and the height of left and right coronary sinuses (р<0,05). The left coronary sinus height had a correlation with height, weight, body mass index (BMI) and BSA (р<0,05). The right coronary sinus height had a correlation with weight, BMI, and BSA (р<0.05). The parameters of the non-coronary sinus in women do not have confirmed direct correlations with any anthropometric measurements observed. The sinuses of Valsalva height is higher in males. The most significant confirmed correlations were between height and left and right coronary sinuses in men and women. Increased size of sinuses in men correlated with an increase of height, weight and decrease of BMI and BSA values.

Selective Sinus Replacement for Aortic Root Aneurysm: Durable Approach in Selected Patients

BackgroundSelective sinus replacement (SSR) allows a tailored repair approach in patients with sinus of Valsalva or asymmetric aortic root aneurysm. SSR avoids the need for coronary reimplantation for nondiseased sinuses and shortens operative time, although potential for late growth of retained sinuses exists. This study describes selection of patients and assesses operative outcomes and late root dimensions after SSR. MethodsFrom 2006 to 2020, 60 patients underwent SSR at a single referral institution. Mixed effect models were used to assess trajectory of postoperative growth of remaining sinuses, adjusting for age of the patient, valve morphology, and baseline root diameter. ResultsMedian age of the patients was 57 (interquartile range [IQR], 48-65) years. Twenty-four (40%) had a bicuspid aortic valve. Most patients (n = 55 [92%]) underwent single sinus replacement (n = 46 noncoronary, n = 9 right), whereas 5 (8%) underwent repair of both the right and noncoronary sinuses. Concomitant aortic valve replacement was performed in 15 patients (25%); aortic valve repair with internal ring annuloplasty or cusp plication was performed in 37 (62%). There was no operative death, stroke, renal failure, or respiratory failure. Median preoperative root diameter was 53 mm (IQR, 51-56 mm) vs 42 mm (IQR, 39-45 mm) at median imaging follow-up of 34 (IQR, 13-49) months. Rate of midterm root growth was 0.2 mm/y, and there were no late root reinterventions. ConclusionsFor patients with sinus of Valsalva or asymmetric root aneurysm, SSR is associated with excellent operative outcomes, and midterm follow-up suggests that the technique is durable. Longer term follow-up is needed to confirm continued stability of the aortic root.

Beware of the commissure - transcatheter aortic valve replacement in a rare anomaly of the left main coronary.

Anomalies of the coronary ostia are a potential challenge to the interventionalist. Commissural alignment has recently been introduced as concept for transcatheter aortic valve replacement (TAVR) to avoid potential coronary obstruction and to facilitate future coronary re-access. Here, we report a case of TAVR in a patient with a rare anomaly of the left coronary artery (LCA)-ostium, originating from the commissure between left- and noncoronary sinus, illustrating a potential pitfall for contemporary TAVR-implantation protocols and discuss the final choice of prosthesis suiting the demands of this distinct anatomical variance.

A word of caution: Spontaneous rupture of the noncoronary sinus of the Freestyle xenograft: Two cases and review of the literature

The porcine stentless Freestyle xenograft (Medtronic Inc) has proved to be an ideal substitute for aortic root replacement (ARR) as it provides excellent hemodynamics and durability.1,2 Nonetheless, like other bioprostheses, structural valve deterioration is observed in the long term, mostly due to aortic cusp tears. However, spontaneous rupture of the Freestyle xenograft aortic wall has also been reported.3,4 We present 2 patients who developed pseudoaneurysm after ARR using a Freestyle xenograft, related to spontaneous rupture of the noncoronary sinus (NCS) of Valsalva.

Oldukça nadir bir koroner arter anomalisi: Non-koroner sinüsten çıkan sol ana koroner arter

Although they are rare, left coronary artery anomalies can cause complications with high mortality, including arrhythmia and cardiac arrest. Left main coronary artery originates from the non-coronary sinus abnormality is rarely observed. This abnormality has been defined as a benign pathology in the past, although it is described in the literature to cause morbidity and mortality in some cases. We present very rare case of the left main coronary artery arising from non-coronary sinus detected on CCTA.

Pseudo Double-Walled Left Atrium: An Extreme Rare Case of Isolated Saccular Aneurysm of Noncoronary Sinus With Rupture into Left Atrium With Severe Eccentric Mitral Regurgitation Secondary to Impingement on Mitral Valve Apparatus in an Octogenarian

Pseudo Double-Walled Left Atrium: An Extreme Rare Case of Isolated Saccular Aneurysm of Noncoronary Sinus With Rupture into Left Atrium With Severe Eccentric Mitral Regurgitation Secondary to Impingement on Mitral Valve Apparatus in an Octogenarian

Rupture of Non-coronary Sinus of Valsalva Aneurysm Contained by Ventricular Wall: A Case Report

Sinus of Valsalva aneurysm is a typically asymptomatic, rare cardiac pathology that is defined as a dilation of a sinus of the aorta. If large enough, the patient may present with symptoms reflective of dysfunction of adjacent structures caused by compressive effect. Sinus of Valsalva aneurysms have high rate of morbidity and mortality in the rare event that they rupture. Consequences of aneurysmal rupture vary depending on which sinus is affected and the location of the aneurysm. Contained aneurysms of this type have rarely been reported. Early surgical intervention is indicated for symptomatic aneurysms and aneurysmal rupture. We present a case of a contained rupture of the non-coronary sinus of Valsalva aneurysm and demonstrate the need to maintain a high index of suspicion in asymptomatic patients who have risk factors for the development of this type of aneurysm.

Rupture of sinus of Valsalva aneurysm: a case report in a child

BackgroundSinus of Valsalva aneurysm (SVA) is a rare congenital disease that can cause severe clinical presentations when the aneurysm ruptures. Here, we report a rare case of a noncoronary sinus of Valsalva aneurysm with rupture into the right atrium.Case presentationA 14-year-old Chinese female patient presented viral myocarditis with acute heart failure at the local hospital, and she was finally diagnosed with a noncoronary sinus Valsalva aneurysm with rupture into the right atrium by digital subtraction angiography with cardiac catheterization angiography and echocardiography at our hospital (Children’s Hospital of Chongqing Medical University). Percutaneous closure intervention was performed shortly after her diagnosis, and the patient showed good functional recovery.ConclusionsWe report a case of ruptured sinus of Valsalva aneurysm successfully treated by percutaneous closure, which is an excellent alternative treatment.

Transcatheter closure of a rare ruptured giant non-coronary Valsalva sinus aneurysm.

Transcatheter closure of a rare ruptured giant non-coronary Valsalva sinus aneurysm.

Differences in Aortic Histopathology in Patients Undergoing Valve Reimplantation Surgery for Various Clinical Syndromes.

Objectives The study aims to investigate aortic histopathologic differences among patients undergoing aortic valve reimplantation, suggest different mechanisms of aortic root aneurysm pathogenesis, and identify factors associated with long-term success of reimplantation. Methods From 2006 to 2017, 568 adults who underwent reimplantation for repair of aortic root aneurysm, including patients with tricuspid aortic valves with no connective tissue disease (TAV/NoCTD, n = 314/568; 55.3%), bicuspid aortic valves (BAVs, n = 86/568; 15.1%), or connective tissue disease (CTD, n = 177/568; 31.2%), were compiled into three comparison groups. Patients with both BAV and CTD ( n = 9/568; 1.6%) were omitted to increase study power. Patient records were analyzed retrospectively, focusing on pathology reports, which were available for 98.42% of patients, and were classified based on their descriptions of aortic tissue samples, primarily from the noncoronary sinus. Mean follow-up time available for patients was 2.97 years. Results Aortitis, medial fibrosis, and smooth muscle loss were more common histopathologic findings in patients with TAV/NoCTD than in patients with BAV and CTD ( p < 0.05). Cystic medial degeneration was most often found in patients with CTD, then TAV/NoCTD, and least in BAV ( p < 0.01). Increases in mucopolysaccharides were found more often in the BAV group than in the TAV/NoCTD and CTD groups ( p < 0.01). There were no differences in the frequency of elastic laminae fragmentation/loss across these three groups. Among all patients, 1.97% ( n = 11/559) had an unplanned reintervention on the aortic valve after reimplantation, but no significant demographic or histopathologic differences were identified. Conclusion Despite some common histopathologic features among patients undergoing aortic valve reimplantation, there were enough distinguishing features among aortic tissue samples of TAV/NoCTD, BAV, and CTD patients to suggest that these groups develop root aneurysms by different mechanisms. No histopathologic features were able to predict the need for late reintervention on the aortic valve.

Contained rupture of a sinus of Valsalva aneurysm: Is it just a matter of luck?

BackgroundContained rupture of the ascending aorta is a rare condition, but the severity of this complication enforces strict guidelines for its prevention and a prompt diagnosis, once already occurred.Case presentationA 66-year-old man with a history of type 2 diabetes, longstanding aortic valve stenosis and aortic root aneurysm of 47 mm was hospital admitted for elective surgery. A Bentall-De Bono procedure was performed in order to replace the stenotic bicuspid aortic valve and exclude the dilated portion of the aortic wall. Intraoperatively, a discontinuity of the aortic wall, just above the aortic annulus, at the non-coronary sinus of Valsalva was incidentally observed. The aortic wall discontinuity was none other than a contained aortic rupture. The preoperative CT-scan images were afterwards analyzed by the radiologist, in order to identify the contained aortic rupture. Indeed a false aneurysm of the non-coronary sinus of Valsalva of a maximum diameter of 15 mm was detected, thanks to a 3D reconstruction.ConclusionsThe diagnosis of contained aortic rupture is certainly demanding, particularly in absence of signs or symptoms of rupture in a chamber of the heart or in the pericardium. Although this case represents a consensus of experts’ opinion, the recognition of these specific cases in which the risk of dissection, rupture or death is at its highest, would allow to operate at the appropriate time, improving the outcomes.

The rotational position of the aortic valve: implications for valve-sparing aortic root replacement.

There are few reports on the rotational position of the aortic valve relative to the base of the left ventricle, and its influence on valve-sparing aortic root replacement (VSRR) has not been reported. Based on our experience with complications such as right atrial perforation and tricuspid valve injury, we investigated the cause of these complications in terms of morphological variations in the aortic root and its surrounding structures. The aortic valve rotation relative to the base of the left ventricle was assessed in 30 patients with tri-leaflet aortic valves who underwent VSRR. The influence of such anatomical variations on surgical procedures was investigated. The aortic valve was positioned normally in 25 patients (83.3%), rotated counterclockwise in 4 (13.3%), and rotated clockwise in 1 patient (3.3%). In patients with a counterclockwise rotated aortic valve, the non-coronary sinus was the largest compared with other sinuses. This aortic valve rotation could be diagnosed by multidetector row computed tomography. In all patients who had difficulty in the external dissection of the right sinus of Valsalva, the aortic valve was counterclockwise rotated and forcible dissection had a risk of right atrial perforation and tricuspid valve injury. Aortic valve rotation is an element that complicates VSRR. The rotational position of the aortic valve can be diagnosed preoperatively using multidetector row computed tomography and understanding the anatomy of the aortic valve related to rotational position help decide proper surgical decision-making in performing aortic root reconstruction procedure.

Repair of a Non-coronary Sinus of Valsalva Aneurysm Rupture

Repair of a Non-coronary Sinus of Valsalva Aneurysm Rupture

Cuffed endotracheal tube as a cardiopulmonary bypass venous return cannula.

Cuffed endotracheal tube as a cardiopulmonary bypass venous return cannula.

"Roof" technique-a modified aortotomy closure in Y-incision aortic root enlargement upsizing 3-4 valve sizes.

"Roof" technique-a modified aortotomy closure in Y-incision aortic root enlargement upsizing 3-4 valve sizes.

Diversity and determinants of the sigmoid septum and its impact on morphology of the outflow tract as revealed using cardiac computed tomography.

The sigmoid septum has been generally evaluated subjectively and qualitatively, without detailed examination of its diversity, impact on the morphology of the left ventricular outflow tract (LVOT), and anatomical background. We enrolled 100 patients without any background cardiac diseases (67.5 ± 12.8 years old; 43% women) who underwent cardiac computed tomography. Basal septal morphology was evaluated using antero-superior and medial bulging angles (bidirectional angulation of the basal septum relative to the LVOT). The eccentricity index of the LVOT, area narrowing ratio (LVOT/virtual basal ring area), aortic-to-left ventricular axial angle (angulation of the aortic root relative to the left ventricle), and wedged height (non-coronary aortic sinus to inferior epicardium distance) were also quantified. The antero-superior bulging, medial bulging, aortic-to-left ventricular axial angles, LVOT eccentricity index, area narrowing ratio, and wedged height were 76° ± 17°, 166° ± 27°, 127° ± 9°, 1.8 ± 0.5, 1.0 ± 0.2, and 41.2 ± 9.1mm, respectively. Both bulging angles were correlated with each other and contributed to the narrowing and deformation of the LVOT. Angulated aortic root was not correlated with either bidirectional septal bulge or LVOT narrowing. Clockwise rotation of the aortic root rotation was an independent predictor of prominent antero-superior septal bulge. Deeper aortic wedging was a common independent predictor of bidirectional septal bulge. The extent of septal bulge varies in normal hearts. Along with deep aortic wedging, the bidirectional bulge of the basal septum deforms and narrows the LVOT without affecting the virtual basal ring morphology.

A novel computational growth framework for biological tissues: Application to growth of aortic root aneurysm repaired by the V-shape surgery

Ascending aortic aneurysms (AsAA) often include the dilatation of sinotubular junction (STJ) and extend proximally into the aortic root, which usually leads to aortic insufficiency. The novel surgery of the V-shape resection of the noncoronary sinus, for treatment of AsAA with root ectasia, has been shown to be a simpler procedure compared to traditional surgeries. Our previous study showed that the repaired aortic root aneurysms grew after the surgery. In this study, we developed a novel computational growth framework to model the growth of the aortic root repaired by the V-shape surgery. Specifically, the unified-fiber-distribution (UFD) model was applied to describe the hyperelastic deformation of the aortic tissue. A novel kinematic growth evolution law was proposed based on existing observations that the growth rate is linearly dependent on the wall stress. Moreover, we also obtained patient-specific geometries of the repaired aortic root post-surgery at two follow-up time points (Post-1 and Post-2) for 5 patients, based on clinical CT images. The novel computational growth framework was implemented into the Abaqus UMAT user subroutine and applied to model the growth of the aortic root from Post-1 to Post-2. Patient-specific growth parameters were obtained by an optimization procedure. The predicted geometry and stress of the aortic root at Post-2 agree well with the in vivo results. The novel computational growth framework and the optimized growth parameters could be applied to predict the growth of repaired aortic root aneurysms for new patients and to optimize repair strategies for AsAA.

Miniseries 1-Part II: the comparative anatomy of the atrioventricular conduction axis.

The arrangement of the conduction axis is markedly different in various mammalian species. Knowledge of such variation may serve to question the validity of using animals as prospective models for design of systems for clinical use. We compared the arrangement of the atrioventricular conduction axis in human, murine, canine, porcine, and bovine hearts, examining serially sectioned datasets from 20 human, 16 murine, 3 porcine, 5 canine, and 1 bovine hearts. We also analysed computed tomographic datasets obtained from bovines and one human heart. Unlike the situation in the human heart, there is no formation of an atrioventricular fibrous membranous septum in the murine, canine, porcine, nor bovine hearts. Canine, porcine, and bovine hearts also lack an infero-septal recess, when defined as a fibrous plate supporting the buttress of the atrial septum. In these species, half of the non-coronary leaflet is directly opposed to the ventricular septal surface. There is a long right-sided non-branching component of the axis, which skirts the attachment of the non-coronary sinus of the aortic root. In the bovine heart, moreover, the left bundle branch usually extends intramyocardially as a solitary tape before surfacing and ramifying on the left ventricular septal surface. The difference in the atrioventricular conduction axis between species may influence the anatomical substrates for atrioventricular re-entry tachycardia, as well as providing inferences for assessing the risks of transcatheter implantation of the aortic valve. Further studies are now needed to assess these possibilities.

Surgical reconstruction of giant non-coronary sinus aneurysm using valve-sparing technique.

Surgical reconstruction of giant non-coronary sinus aneurysm using valve-sparing technique.

Transthoracic minimally invasive closure for the treatment of ruptured sinus of Valsalva aneurysm: immediate and mid-term follow-up results.

BackgroundWe aimed to evaluate the immediate and mid-term outcomes of transthoracic minimally invasive closure (TMIC) of ruptured sinus of Valsalva aneurysm (RSVA), which is a rare and mostly congenital heart disease.MethodsFrom January 2014 to November 2020, 19 patients (16 males, 3 females) with RSVA were selected for TMIC and were followed up at our centre. Data were analysed from our prospectively collected database and clinical mid-term follow-up was obtained.ResultsAmong these 19 cases, transthoracic echocardiography showed rupture of the right coronary sinus to the right atrium in 9 patients, non-coronary sinus rupture to the right atrium in 7 patients, and right coronary sinus rupture to the right ventricle in 3 patients. Most (13/19) cases were New York Heart Association (NYHA) functional class III or IV. The mean diameters of the defect from the aortic end and ruptured site were 8.8±3.0 and 6.4±2.6 mm, respectively. TMIC was attempted using ventricular septal defect (VSD)/patent ductus arteriosus (PDA) occluders 2–7 mm larger than the aortic ends of the defects. All patients were successfully treated by TMIC and achieved complete closure at discharge after a mean hospital stay length of 6.2±2.5 days. Seventeen patients were NYHA class I while 2 patients were NYHA class II. No cases of residual shunts, device embolization, infective endocarditis, or aortic regurgitation were observed during a median follow-up of 36 months (range, 16–84 months).ConclusionsIn appropriately selected cases with RSVA, TMIC is an attractive alternative to surgery, with a high technical success rate and encouraging short-term and mid-term outcomes. However, long-term follow-up is needed.