Aortic root and valve proportions: an example of the golden ratio?

Area of Science:

• Cardiovascular imaging
• Cardiac anatomy
• Aortic valve disease

Background:

• Calcific aortic stenosis is a common indication for valve replacement.
• Transcatheter aortic valve replacement (TAVR) procedures are increasing, but detailed aortic valve and root anatomy data are limited.
• Understanding anatomical variations is crucial for procedural success and patient outcomes.

Purpose of the Study:

• To examine the size and proportions of aortic valve leaflets, sinuses of Valsalva, and sinotubular junction using cardiac CT.
• To investigate anatomical differences based on sex, age, and race.
• To explore potential relationships between aortic root anatomy and natural ratios.

Main Methods:

• Retrospective analysis of 150 gated cardiac CT scans.
• Measurements included cusp area, sinus height and width, annular perimeter, mid-sinus perimeter, and sinotubular junction perimeter.
• Statistical analysis was performed to assess variations by sex, age, and race.

Main Results:

• The right coronary cusp was largest, followed by the non-coronary and then the left coronary cusp.
• Cusps were larger in men than women, even after body surface area indexing.
• Indexed sinus width and height did not differ by sex; no significant racial differences were found.
• Mid-sinus and sinotubular junction perimeters increased with age.
• The ratio of average sinus height to annular radius approximated the golden ratio (1.69 vs. 1.62).

Conclusions:

• Significant differences exist in aortic cusp size related to sex.
• Age influences aortic root dimensions, specifically mid-sinus and sinotubular junction perimeters.
• The anatomical proportions of the aortic root may be related to the golden ratio, potentially impacting hemodynamics and vortex formation.