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Interventional Anatomy of Aortic Valve

  • Stefania Rizzo
  • Monica de Gaspari
  • Gaetano Thiene
  • Cristina BassoEmail author
Chapter

Abstract

The knowledge of aortic root anatomy is relevant in the current era of interventional therapeutic strategies for aortic valve disease, through transcatheter aortic valve implantation (TAVI). In this procedure, the native aortic valve is crushed against the aortic wall and into the sinuses of Valsalva via either a transapical (through the left ventricular apex) or a transarterial catheter by a balloon- or self-expandable stent carrying a bioprosthetic valve. Anatomic factors influencing a safe and proper device deployment during TAVI include annular diameters, sinuses of Valsalva dimensions, and coronary ostia location; calcium deposits size (bulkiness) and location; subaortic septum thickness and morphology; and relationship with the membranous septum and the mitral valve.

The aim of the present chapter is to review the anatomy of the aortic root relevant for interventional cardiologist to avoid risk of complications, such as prosthesis embolization, improper positioning, coronary obstruction, paravalvular regurgitation, annular and root rupture, conduction system disturbances, and mitral valve injury.

Keywords

Transcatheter aortic valve implantation Aortic root anatomy Aortic stenosis Complications 

References

  1. 1.
    Cribier A, Eltchaninoff H, Bash A, Borenstein N, Tron C, Bauer F, Derumeaux G, Anselme F, Laborde F, Leon MB. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation. 2002;106:3006–8.CrossRefGoogle Scholar
  2. 2.
    Basso C, Rizzo S, Thiene G. Anatomy: the pathology of aortic incompetence. In: Schafers J, editor. Current treatment of aortic regurgitation. Bremen: Uni-Med Verlag; 2013. p. 15–31. ISBN: 9783837414066.Google Scholar
  3. 3.
    Roberts WC, Stoler RC, Grayburn PA, Hebeler RF Jr, Ko JM, Brown DL, Brinkman WT, Mack MJ, Guileyardo JM. Necropsy findings early after transcatheter aortic valve implantation for aortic stenosis. Am J Cardiol. 2013;111:448–52.CrossRefGoogle Scholar
  4. 4.
    Loeser H, Wittersheim M, Puetz K, Friemann J, Buettner R, Fries JW. Potential complications of transcatheter aortic valve implantation (TAVI)-an autopsy perspective. Cardiovasc Pathol. 2013;22:319–23.CrossRefGoogle Scholar
  5. 5.
    Fishbein GA, Schoen FJ, Fishbein MC. Transcatheter aortic valve implantation: status and challenges. Cardiovasc Pathol. 2014;23:65–70.CrossRefGoogle Scholar
  6. 6.
    van Kesteren F, Wiegerinck EM, Rizzo S, Baan J Jr, Planken RN, von der Thüsen JH, Niessen HW, van Oosterhout MF, Pucci A, Thiene G, Basso C, Sheppard MN, Wassilew K, van der Wal AC. Autopsy after transcatheter aortic valve implantation. Virchows Arch. 2017;470:331–9.CrossRefGoogle Scholar
  7. 7.
    Turri M, Thiene G, Bortolotti U, Milano A, Mazzucco A, Gallucci V. Surgical pathology of aortic valve disease. A study based on 602 specimens. Eur J Cardiothorac Surg. 1990;4:556–60.CrossRefGoogle Scholar
  8. 8.
    Roberts WC, Janning KG, Ko JM, Filardo G, Matter GJ. Frequency of congenitally bicuspid aortic valves in patients ≥80 years of age undergoing aortic valve replacement for aortic stenosis (with or without aortic regurgitation) and implications for transcatheter aortic valve implantation. Am J Cardiol. 2012;109:1632–6.CrossRefGoogle Scholar
  9. 9.
    Basso C, Boschello M, Perrone C, Mecenero A, Cera A, Bicego D, Thiene G, De Dominicis E. An echocardiographic survey of primary school children for bicuspid aortic valve. Am J Cardiol. 2004;93:661–3.CrossRefGoogle Scholar
  10. 10.
    Nistri S, Grande-Allen J, Noale M, Basso C, Siviero P, Maggi S, Crepaldi G, Thiene G. Aortic elasticity and size in bicuspid aortic valve syndrome. Eur Heart J. 2008;29:472–9.CrossRefGoogle Scholar
  11. 11.
    Piazza N, de Jaegere P, Schultz C, Becker AE, Serruys PW, Anderson RH. Anatomy of the aortic valvar complex and its implications for transcatheter implantation of the aortic valve. Circ Cardiovasc Interv. 2008;1:74–81.CrossRefGoogle Scholar
  12. 12.
    Anderson RH. Anatomy: clinical anatomy of the aortic root. Heart. 2000;84:670–3.CrossRefGoogle Scholar
  13. 13.
    Anderson RH, Devine WA, Ho SY, et al. The myth of the aortic annulus: the anatomy of the subaortic outflow tract. Ann Thorac Surg. 1991;52:640–6.CrossRefGoogle Scholar
  14. 14.
    Doddamani S, Bello R, Friedman MA, et al. Demonstration of left ventricular outflow tract eccentricity by real time 3D echocardiography: implications for the determination of aortic valve area. Echocardiography. 2007;24:860–6.CrossRefGoogle Scholar
  15. 15.
    Schoen FJ. Aortic valve structure-function correlations: role of elastic fibers no longer a stretch of the imagination. J Heart Valve Dis. 1997;6:1–6.PubMedGoogle Scholar
  16. 16.
    Razzolini R, Longhi S, Tarantini G, Rizzo S, Napodano M, Abate E, Fraccaro C, Thiene G, Iliceto S, Gerosa G, Basso C. Relation of aortic valve weight to severity of aortic stenosis. Am J Cardiol. 2011;107:741–6.CrossRefGoogle Scholar
  17. 17.
    Tarantini G, Gasparetto V, Napodano M, Fraccaro C, Gerosa G, Isabella G. Valvular leak after transcatheter aortic valve implantation: a clinician update on epidemiology, pathophysiology and clinical implications. Am J Cardiovasc Dis. 2011;1:312–20.PubMedPubMedCentralGoogle Scholar
  18. 18.
    Himbert D, Pontnau F, Messika-Zeitoun D, et al. Feasibility and outcomes of transcatheter aortic valve implantation in high-risk patients with stenotic bicuspid aortic valves. Am J Cardiol. 2012;110:877–83.CrossRefGoogle Scholar
  19. 19.
    Zhao ZG, Jilaihawi H, Feng Y, Chen M. Transcatheter aortic valve implantation in bicuspid anatomy. Nat Rev Cardiol. 2015;12:123–8.CrossRefGoogle Scholar
  20. 20.
    Muriago M, Sheppard MN, Ho SY, Anderson RH. Location of the coronary arterial orifices in the normal heart. Clin Anat. 1997;10:297–302.CrossRefGoogle Scholar
  21. 21.
    Cavalcanti JS, de Melo NC, deVasconcelos RS. Morphometric and topographic study of coronary ostia. Arq Bras Cardiol. 2003;81:359–62.CrossRefGoogle Scholar
  22. 22.
    Manghat NE, Morgan-Hughes GJ, Marshall AJ, et al. Multidetector row computed tomography: imaging congenital coronary artery anomalies in adults. Heart. 2005;91:1515–22.CrossRefGoogle Scholar
  23. 23.
    Falk V, Baumgartner H, Bax JJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease: the Task Force for the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg. 2017;52:616–64.CrossRefGoogle Scholar
  24. 24.
    Ribeiro HB, Nombela-Franco L, Urena M, Mok M, Pasian S, Doyle D, et al. Coronary obstruction following transcatheter aortic valve implantation: a systematic review. JACC Cardiovasc Interv. 2013;6:452–61.CrossRefGoogle Scholar
  25. 25.
    Jabbour RJ, Tanaka A, Finkelstein A, et al. Delayed coronary obstruction after transcatheter aortic valve replacement. J Am Coll Cardiol. 2018;71:1513–24.CrossRefGoogle Scholar
  26. 26.
    Sutton JPIII, Ho SY, Anderson RH. The forgotten interleaflet triangles: a review of the surgical anatomy of the aortic valve. Ann Thorac Surg. 1995;59:419–27.CrossRefGoogle Scholar
  27. 27.
    Mori S, Tretter JT, Toba T, et al. Relationship between the membranous septum and the virtual basal ring of the aortic root in candidates for transcatheter implantation of the aortic valve. Clin Anat. 2018;31:525–34.CrossRefGoogle Scholar
  28. 28.
    Tarantini G, Basso C, Fovino LN, Fraccaro C, Thiene G, Rizzo S. Left ventricular outflow tract rupture during transcatheter aortic valve implantation: anatomic evidence of the vulnerable area. Cardiovasc Pathol. 2017;29:7–10.CrossRefGoogle Scholar
  29. 29.
    Basso C, Ho Y, Rizzo S, Thiene G. Anatomic and histopathologic characteristics of the conductive tissues of the heart. In: Gussak I, Antzelevitch C, editors. Electrical diseases of the heart. London: Springer; 2013. p. 1–25. ISBN: 9781447148814.Google Scholar
  30. 30.
    Auffret V, Puri R, Urena M, et al. Conduction disturbances after transcatheter aortic valve replacement: current status and future perspectives. Circulation. 2017;136:1049–69.CrossRefGoogle Scholar
  31. 31.
    Fraccaro C, Buja G, Tarantini G, Gasparetto V, Leoni L, Razzolini R, Corrado D, Bonato R, Basso C, Thiene G, Gerosa G, Isabella G, Iliceto S, Napodano M. Incidence, predictors, and outcome of conduction disorders after transcatheter self-expandable aortic valve implantation. Am J Cardiol. 2011;107:747–54.CrossRefGoogle Scholar
  32. 32.
    Roten L, Wenaweser P, Delacrtaz E, et al. Incidence and predictors of atrioventricular conduction impairment after transcatheter aortic valve implantation. Am J Cardiol. 2010;106:1473–80.CrossRefGoogle Scholar
  33. 33.
    Cortés C, Amat-Santos IJ, Nombela-Franco N, Muñoz-Garcia AJ, Gutiérrez-Ibanes E, De La Torre Hernandez JM, et al. Mitral regurgitation after transcatheter aortic valve replacement. JACC Cardiovasc Interv. 2016;9:1603–14.CrossRefGoogle Scholar
  34. 34.
    Abramowitz Y, Kazuno Y, Chakravarty T, Kawamori H, Maeno Y, Anderson D, et al. Concomitant mitral annular calcification and severe aortic stenosis: prevalence, characteristics and outcome following transcatheter aortic valve replacement. Eur Heart J. 2017;38:1194–203.PubMedGoogle Scholar
  35. 35.
    Wong DR, Boone RH, Thompson CR, Allard MF, Altwegg L, Carere RG, et al. Mitral valve injury late after transcatheter aortic valve implantation. J Thorac Cardiovasc Surg. 2009;137:1547–9.CrossRefGoogle Scholar
  36. 36.
    Otto CM, Kumbhani DJ, Alexander KP, Calhoon JH, Desai MY, Kaul S, et al. 2017 ACC expert consensus decision pathway for transcatheter aortic valve replacement in the management of adults with aortic stenosis: a report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol. 2017;69:1313–46.CrossRefGoogle Scholar
  37. 37.
    D’Onofrio A, Rizzo S, Besola L, Isabella G, Rancitelli V, Randi ML, Campello E, Falasco G, Basso C, Thiene G, Gerosa G. Hyperacute valve thrombosis after transapical transcatheter aortic valve replacement in a patient with polycythemia vera. JACC Cardiovasc Interv. 2016;9:1746–7.CrossRefGoogle Scholar
  38. 38.
    Santos M, Thiene G, Sievers HH, Basso C. Candida endocarditis complicating transapical aortic valve implantation. Eur Heart J. 2011;32:2265.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Stefania Rizzo
    • 1
  • Monica de Gaspari
    • 1
  • Gaetano Thiene
    • 1
  • Cristina Basso
    • 1
    Email author
  1. 1.Cardiovascular PathologyUniversity of PaduaPaduaItaly

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