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Morphological variability of the arterial valve in common arterial trunk and the concept of normality
  1. Gabriel Romero Liguori1,
  2. Marcelo Biscegli Jatene2,
  3. Siew Yen Ho3,
  4. Vera Demarchi Aiello1
  1. 1Laboratory of Pathology, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
  2. 2Pediatric Cardiac Surgery Unit, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
  3. 3Royal Brompton Hospital, National Heart and Lung Institute, Imperial College London Faculty of Medicine, London, UK
  1. Correspondence to Dr Gabriel Romero Liguori, Laboratory of Pathology, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 44—Bloco I—Subsolo, São Paulo, SP 05403-000, Brazil; gabriel.liguori{at}usp.br

Abstract

Objective Until now, no study established a morphometric evaluation of the truncal valve dysplasia and a description of its different presentation patterns. Thus, authors conducted an anatomopathological study describing the gross features and histological findings of the truncal valve.

Methods 50 common arterial trunk (CAT) specimens were examined. The number of valvar leaflets was determined and valvar dysplasia was classified as absent, mild, moderate or severe. Selected leaflets were sectioned and submitted to histological analysis and linear measurements (thickness, length and area), besides quantification of collagen area fraction.

Results 28 (56%) valves presented three, 15 (30%) four and 7 (14%) two leaflets. Valvar dysplasia was absent in 13 (26%) cases, mild in 19 (38%), moderate in 6 (12%) and severe in 12 (24%). A significant association was found between the presence of four leaflets and valvar dysplasia (p<0.001). Single coronary ostium was more common in two-leaflet cases than in three-leaflet cases (p=0.037). Leaflets medial thirds were thicker in the more dysplastic valves (p=0.006) and in those presenting anarchic collagen distribution (p=0.002).

Conclusions CAT semilunar valves present two main patterns. The first characterised by three leaflets and absent or mild dysplasia and the second by four leaflets and severe dysplasia. Still, great variability regarding thickness, microscopic organisation of the extracellular matrix and proportions of leaflets' dimensions exists, which may impact on the surgical outcomes.

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Footnotes

  • Twitter Follow Gabriel Liguori at @gabrielliguori and Vera Aiello at @vdaiello1

  • Contributors GRL has contributed to the conception and design of the work, data collection, data analysis and interpretation, drafting the article, critical revision of the article and final approval of the version to be published. MBJ has contributed to the critical revision of the article and final approval of the version to be published. SYH has contributed to the data analysis and interpretation, drafting the article, critical revision of the article and final approval of the version to be published. VDA has contributed to the conception and design of the work, data analysis and interpretation, drafting the article, critical revision of the article and final approval of the version to be published.

  • Funding This project was supported by the São Paulo Research Foundation (FAPESP research grants 10/16663-0, 10/16811-0 and 12/06735-0).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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