Left ventricular rigor mortis interferes with postmortem aortic root geometry

Aortic regurgitation is a common valve disease and can be caused by delineated findings such as fenestrations or hardly discernible alterations of the aortic root geometry. Therefore, aortic regurgitation can be a challenging diagnosis during an autopsy. Cardiac surgeons, however, are confronted with comparable problems during surgery and have developed a refined knowledge of the anatomy of the aortic root including its geometry. Transferring this knowledge from the operating room to the dissection would further complement the panel of postmortem diagnostic tools. To foster translation of the clinical anatomy, the present study assessed the impact of postmortem peculiarities (i.e. myocardial rigor mortis, putrefaction) that might influence aortic root geometry. The aortic root geometry was described by aortic perimeters (basal, sinus, sino-tubular junction, and ascending aorta), effective height (distance from the cusp's free margin to its nadir), geometric height (cusp height), commissural height (distance from the base of an interleaflet triangle to the end of a commissure), and length of the ascending aorta. Data from 140 cases were analyzed (linear regression, comparative testing). Myocardial rigor mortis was associated with smaller basal rings. Weak positive correlations between the duration of the postmortem interval and aortic root dimensions were observed. In summary, postmortem peculiarities, especially the myocardial cadaveric rigidity, influence postmortem aortic root geometry. Despite these circumstances, the current study demonstrates that aortic root geometric assessment, including effective height, is feasible in a postmortem setting. Further studies are needed to elaborate on aortic root geometry as a diagnostic tool in a necropsy setting.