• Gil Marom, Rami Haj-Ali, Moshe Rosenfeld, Hans Joachim Schäfers, and Ehud Raanani.
• School of Mechanical Engineering, Tel Aviv University Faculty of Engineering, Tel Aviv, Israel.
• J. Thorac. Cardiovasc. Surg.. 2013 Feb 1;145(2):406-411.e1.

ObjectiveThe aim of the present study was to determine the influence of the aortic annulus (AA) diameter in order to examine the performance metrics, such as maximum principal stress, strain energy density, coaptation area, and effective height in the aortic valve.MethodsSix cases of aortic roots with an AA diameter of 20 and 30 mm were numerically modeled. The coaptation height and area were calculated from 3-dimensional fluid structure interaction models of the aortic valve and root. The structural model included flexible cusps in a compliant aortic root with material properties similar to the physiologic values. The fluid dynamics model included blood hemodynamics under physiologic diastolic pressures of the left ventricle and ascending aorta. Furthermore, zero flow was assumed for effective height calculations, similar to clinical measurements. In these no-flow models, the cusps were loaded with a transvalvular pressure decrease. All other parameters were identical to the fluid structure interaction models.ResultsThe aortic valve models with an AA diameter range of 20 to 26 mm were fully closed, and those with an AA diameter range of 28 to 30 mm were only partially closed. Increasing the AA diameter from 20 to 30 mm decreased the averaged coaptation height and normalized cusp coaptation area from 3.3 to 0.3 mm and from 27% to 2.8%, respectively. Increasing the AA diameter from 20 to 30 mm decreased the effective height from 10.9 to 8.0 mm.ConclusionsA decreased AA diameter increased the coaptation height and area, thereby improving the effective height during procedures, which could lead to increased coaptation and better valve performance.Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

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