Histomorphometric evaluation of the arterial valve in Persistent Common Arterial trunk its and possible relation to coronary and aortic arch abnormalities

Abstract

Introduction: Hearts with common arterial trunk (CAT) may show dysplastic arterial valve, which appear to impact on early deaths and on the postoperative prognosis. The morphology of dysplastic leaflets is still poorly defined and usually described qualitatively in the literature as nonspecific fibrous thickening of their margins. Abnormalities of the coronary arteries and of the aortic arch arteries have also been described in CAT, but to date no study has sought to establish objective relations between the truncal valve abnormalities and other morphological features. OBJECTIVE: Systematically assess, both qualitatively and quantitatively, alterations of the truncal valve and check for possible associations with coronary and aortic arch anomalies. Methods: Thirteen heart specimens with CAT were analyzed. Gross features of the coronary ostia (number, position and shape) and aortic arch were annotated. The thickest semilunar leaflet was sampled for histological analysis. Linear measurements were obtained: proximal, medial and distal thicknesses, length and total area of the leaflet. Results: The thickest valvar segments were the medial and distal ones. There was a negative correlation between the distal thickness of the leaflet and the linear distance from the coronary ostium to the valvar commissure (R2 = 0.448; P = 0.024 and R2 = 0.697; P = 0.001, respectively for the left and right coronary ostia). The groups with patent arterial duct and abnormal subclavian artery presented greater medial (P = 0.048; P = 0.044) and distal (P = 0.013; P = 0.028) thickness of the semilunar leaflet. Conclusion: Anomalies of the position (juxtacommissural origin) of the coronary ostia and aortic arch abnormalities are related to the dysplasia of the truncal valve.