Background. Valve-sparing aortic root replacement with aortic valve reimplantation is a rapidly developing method of treatment of ascending aortic aneurysm. The improvement of the results of this method is inextricably linked with the understanding of the relationships between the initial functional and planimetric characteristics of the valvular-aortic complex, the technical aspects of the reimplantation procedure and the results obtained.Objective. To search and analyze previously little-studied factors — the planimetric characteristics of the aortic valve and the aortic root.Design and methods. High-precision assessment of the planimetry of the aortic flaps requires precision visualization methods and subsequent creation of virtual three-dimensional models. The creation of high-precision reconstructions became possible due to the introduction of specialized computer-aided design environments into clinical practice. Due to the technical complexity, none of the known methods has previously been used to accurately measure all the structures of the aortic root in a large group of patients. Simplification, acceleration of reconstruction construction, as well as scaling of this technique remain unresolved tasks.Results. The main result of this work is the development of an algorithm of segmentation of the aortic root and the construction of a high-precision three-dimensional model of the aortic valve, as well as the practical implementation of an algorithm for determining main planimetric parameters of the aortic root with the possibility of scaling to a large group of patients.Conclusion. The method makes it possible to construct a high-precision three-dimensional reconstruction of the internal structures of the aortic root within a few hours and is valuable both for determining the tactics and technical features of surgical treatment of the patient, and for studying the effect of the anatomy of the aortic root on the development of recurrence of aortic insufficiency after valve-sparing surgery.

Aneurysm of the aortic root accompanied by aortic insufficiency is a common cardiovascular pathology. The optimal method of surgical treatment of this pathology is the reimplantation of the aortic valve into the aortic root synthetic prosthesis (David procedure). Currently, there is no comprehensive data on the influence of initial geometric parameters of the aortic root structures on the functioning of the reimplanted aortic valve after valve-preserving aortic root replacement. We have introduced a novel technique for creation and segmentation of a three-dimensional reconstruction of the aortic valve and root, which involves the sequential application of two computer-aided design environments: In Vesalius v 3.1.1 (Centro de Tecnologia da Informação Renato Archer (CTI)) and 3-Matic v. 13.0 (Materialise, Leuven, Belgium). The proposed method allows accurate measurement and evaluation of spatial parameters of the AV leaflets, fibrous ring, sinuses of Valsalva and sinotubular junction. The developed technique was used to evaluate the anatomical and functional features of the aortic valve in a 68-year-old patient who underwent David I procedure. Segmentation and measurement of the geometric parameters of the aortic root were performed before operation, as well as 18 months after surgical treatment. To assess the function of the reimplanted aortic valve during the long-term follow-up, a detailed echocardiographic assessment was used. Echocardiographic assessment included measuring volume and area of the regurgitation flow, the width of vena contracta, and the regurgitation fraction. The application of high-precision 3D reconstruction opens up additional opportunities in the field of surgical treatment of the aortic root and AV pathology: advantages in choosing an individual patient-oriented surgical tactics, parameters of the implanted surgical material and/or device, and in predicting long-term results of surgical treatment.

Федеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр имени В. А. Алмазова» Министерства здравоохранения Российской Федерации, Научный центр мирового уровня «Центр персонализированной медицины»,

Calcific aortic stenosis is one of the most common valvular heart diseases, which may require surgery. Regardless of the etiology, the consequence of this disease is concentric hypertrophy of the left ventricle and progressive myocardial fibrosis, independently affecting the long-term survival of patients after aortic valve replacement. "Open" surgical or transcatheter aortic valve replacement is the only effective way to treat aortic stenosis. "Open" surgical procedure remains the "gold standard", however, transcatheter aortic valve replacement is characterized by rapid development and expansion to the population of moderate and low-risk patients. For a comparative assessment of the effectiveness and safety of transcatheter and "open" surgical procedures in patients of different risk categories, OBSERVANT, NOTION, PARTNER, случаев, с применением бесшовных протезов аортального клапана. Таким образом, вопрос об оптимальном методе коррекции тяжелого аортального стеноза у пациентов умеренного и высокого хирургического риска остается открытым. В процессе ведения подобных больных важно учитывать индивидуальные особенности пациентов и стремиться к персонализации лечения.Ключевые слова: аортальный клапан, аортальный стеноз, гипертрофия, протезирование клапана сердца, транскатетерное протезирование аортального клапана, фиброз.