RT Journal Article
SR Electronic
T1 Variations in rotation of the aortic root and membranous septum with implications for transcatheter valve implantation
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 999
OP 1005
DO 10.1136/heartjnl-2017-312390
VO 104
IS 12
A1 Justin T Tretter
A1 Shumpei Mori
A1 Farhood Saremi
A1 Sathish Chikkabyrappa
A1 Kristen Thomas
A1 Fang Bu
A1 Rohit S Loomba
A1 Tarek Alsaied
A1 Diane E Spicer
A1 Robert H Anderson
YR 2018
UL http://heart.bmj.com/content/104/12/999.abstract
AB Objective It is intuitive to suggest that knowledge of the variation in the anatomy of the aortic root may influence the outcomes of transcatheter implantation of the aortic valve (TAVI). We have now assessed such variation.Methods We used 26 specimens of normal hearts and 78 CT data sets of adults with a mean age of 64±15 years to measure the dimensions of the membranous septum and to assess any influence played by rotation of the aortic root, inferring the relationship to the atrioventricular conduction axis.Results The aortic root was positioned centrally in the majority of both cohorts, although with significant variability. For the cadaveric hearts, 14 roots were central (54%), 4 clockwise-rotated (15%) and 8 counterclockwise-rotated (31%). In the adult CT cohort, 44 were central (56%), 21 clockwise-rotated (27%) and 13 counterclockwise-rotated (17%). A mean angle of 15.5° was measured relative to the right fibrous trigone in the adult CT cohort, with a range of −32° to 44.7°. The dimensions of the membranous septum were independent of rotation. Fibrous continuity between the membranous septum and the right fibrous trigone increased with counterclockwise to clockwise rotation, implying variation in the relationship to the atrioventricular conduction axis.Conclusions The central fibrous body is wider, providing greater fibrous support, in the setting of clockwise rotation of the aortic root. Individuals with this pattern may be more vulnerable to conduction damage following TAVI. Knowledge of such variation may prove invaluable for risk stratification.