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J Thorac Cardiovasc Surg 2002;123:911-918
© 2002 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease (ACD)

Dynamic balance of the aortomitral junction

From The International Heart Institute of Montana Foundation at St Patrick Hospital^a and The University of Montana,^b Missoula, Mont.

Received for publication May 29, 2001. Revisions requested July 27, 2001; revisions received Sept 19, 2001. Accepted for publication Oct 16, 2001. Address for reprints: Carlos M. G. Duran, MD, PhD, The International Heart Institute of Montana, 554 West Broadway, Missoula, MT 59802 (E-mail: duran{at}saintpatrick.org).

Objective: The aortic and mitral valves have been studied in isolation, as if their functions were independent. We hypothesized that both valves work in synchrony on the basis of the shared myocardial pump and orifice.
Methods: Six sonometric crystals (7 sheep) were placed in both trigones, the midpoint of the anterior and posterior anulus, and the lateral extremities of the posterior anulus. In a separate series of animals, 3 crystals (8 sheep) were implanted in the aortic annular base of the right, left, and noncoronary sinuses of Valsalva. In an acute, open-chest model, under stable hemodynamic conditions, geometric changes were time related to simultaneous left ventricular and aortic pressures.
Results: From mid-diastole to end-systole, the mitral anulus area contracted by -16.1% ± 1.9% (mean ± SEM), whereas the aortic base area expanded by +29.8% ± 3.3% during systole. The mitral anulus deformation was heterogeneous. In systole, the anterior mitral anulus expanded (intertrigonal distance, +11.5% ± 2.3%) and the posterior mitral anulus contracted (distance between lateral extremities of the posterior anulus, -12.1% ± 1.5%). The intertrigonal distance corresponded to the base of the left and noncoronary sinus of Valsalva, which expanded similarly during systole (+12.9% ± 2.0%). The anteroposterior diameter of the mitral anulus was reduced twice that of the transverse diameter. This disparity of reduction can be explained by the posterior displacement of the intertrigonal area corresponding to the systolic aortic root expansion.
Conclusions: Mitral anulus deformation is closely related to aortic root dynamics. During systole, the posterior movement of the aortic curtain allows for aortic root expansion, probably to maximize ejection, whereas during diastole, aortic root reduction participates in mitral anulus dilatation. These findings should affect mitral and aortic surgical approaches.

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