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Relationships between the dimensions of the human aortic and pulmonary valve leaflets: implications on Ross'
M T Santiago1, J Quelroz e Melo, E Ducla-Soares
1Institute of Biophysics and Biomedical Engineering, Faculty of Sciences, University of Lisbon, Portugal.
Abstract:
The technique of replacing the aortic valve with the patient's pulmonary valve and the implantation of a homograft in the pulmonary position was first introduced by D. Ross in 1967. Despite the many advantages and successes of this procedure, it frequently results in some degree of valve insufficiency. In order to optimize the results of Ross' operation, we carried out a comparative study (n = 22) of the relative dimensions of the human aortic and pulmonary valve leaflets using a digitizer. The digitizer supplies the spatial coordinates of a given point (in a pre-chosen reference frame), by the positioning of its sensor on that point. By digitizing relevant points marked on the arterial wall we were able to calculate the distance between the commissures and the perimeter of each leaflet. Analysing the values thus obtained, we found that in 17 of the 22 cases studied (77.3%) there was one orientation (out of the three anatomically possible orientations) of the pulmonary valve, relative to the configuration of the recipient aortic root, that was clearly better than the other two. This study led to the formulation of a "rule" that, in most of the cases studied (86.4%), led to the best fitting orientation of the autograft using the knowledge of the intercommissural distances.