Geometric models of the aortic and pulmonary roots:: suggestions for the Ross procedure

Objective: To discuss geometric factors, which may influence long-term results relating to homograft competence following the Ross procedure, we describe the 3D morphology of the pulmonary and aortic roots. Materials: Measurements were made on 25 human aortic and pulmonary roots. Inter-commissural distances and the heights of the sinuses were measured. For geometrical reconstruction the three commissures and their vertical projections at the root base were used as reference points. Results: In the pulmonary root, the three inter-commissural distances were of similar dimensions (17.9 +/- 1.6 mm, 17.5 +/- 1.4 mm and 18.6 +/- 1.5 mm). In the aortic root, the right inter-commissural distance was greatest (18.8 +/- 1.9 mm), followed by the non-coronary (17.4 +/- 2.0 mm) and left coronary sinus commissures (15.2 +/- 1.9 mm). The mean height of the left pulmonary sinus was greatest (20 +/- 1.7 mm) followed by the anterior (17.5 1.4 mm) and right pulmonary sinus (18 +/- 1.66 mm). In the aortic root, the height of the right coronary sinus was the greatest (19.4 +/- 1.9 mm) followed by the heights of the non-coronary (17.7 +/- 1.8 mm) and left coronary sinus (17.4 +/- 1.4 mm). Measured differences between parameters determine the tilt angle and direction of the root vector. The tilt angle in the pulmonary root averaged 16.26 degrees, respectively; for the aortic roots, it was 5.47 degrees. Conclusions: Herein we suggest that the left pulmonary sinus is best implanted in the position of the right coronary sinus, the anterior pulmonary in the position of the non-coronary sinus and the right pulmonary sinus in the position of the left coronary sinus. In this way, the direction of the pulmonary root vector will be parallel to that of the aortic root vector. (c) 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.