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Variations in rotation of the aortic root and membranous septum with implications for transcatheter valve implantation

Lookup NU author(s): Professor Bob Anderson


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© 2018 BMJ Publishing Group. All rights reserved. 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.

Publication metadata

Author(s): Tretter JT, Mori S, Saremi F, Chikkabyrappa S, Thomas K, Bu F, Loomba RS, Alsaied T, Spicer DE, Anderson RH

Publication type: Article

Publication status: Published

Journal: Heart

Year: 2018

Volume: 104

Issue: 12

Pages: 999-1005

Print publication date: 01/06/2018

Online publication date: 16/11/2017

Acceptance date: 30/10/2017

ISSN (print): 1355-6037

ISSN (electronic): 1468-201X

Publisher: BMJ Publishing Group


DOI: 10.1136/heartjnl-2017-312390


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