Preoperative Computed Tomography Scan Analysis of Interleaflets Triangles to Guide Aortic Root Repair Procedures

Area of Science:

• Cardiac surgery
• Cardiovascular imaging
• Anatomical studies

Background:

• Dilation of the ventriculo-aortic junction (VAJ) is a risk factor for aortic valve repair failure.
• Interleaflets triangles are crucial VAJ components but are difficult to visualize with echocardiography.
• Three-dimensional (3D) reconstruction of computed tomography (CT) scan images offers detailed VAJ analysis.

Purpose of the Study:

• To develop and validate a CT-scan-based method for visualizing and measuring interleaflets triangles.
• To evaluate the apical angles of subcommissural triangles using 3D CT reconstructions.
• To compare CT-derived measurements with post-mortem data for validation.

Main Methods:

• A novel method using multiplanar post-processing of CT scan images was developed to visualize interleaflets triangles.
• Focus was placed on evaluating the apical angles of these triangles.
• CT scan data were compared against measurements from a prior post-mortem study.

Main Results:

• CT scan group angles between coronary sinuses were approximately 46.23°, 47.38°, and 45°.
• Post-mortem group angles were similar, measuring 45.44°, 48.31°, and 50.25°.
• No statistically significant differences were found between CT scan and post-mortem measurements (p > 0.05).

Conclusions:

• A classification system for subcommissural triangles (acute, equilateral, obtuse) based on angles can guide surgical repair.
• 3D CT reconstruction provides a validated method for preoperative evaluation of VAJ and subcommissural triangles.
• This imaging approach enables personalized surgical planning for aortic valve repair.