Key result
In a retrospective review of 146 patients, shorter left main stem length (average 12 mm) was associated with left coronary artery dominance compared to right coronary artery dominance (average 14.06 mm).
Why the study?
Perception of the aortic root has historically focused on internal structures, leaving an external myocardial component—the left ostial process—largely ignored despite potential developmental and physiological roles.
The authors propose that the myocardial component on the external aspect of the aortic root (the 'left ostial process') deserves greater recognition for its potential roles in cardiac embryology and physiology.
No immediate changes to aortic root surgery; leaves open the embryologic and physiologic roles of the left ostial process for further study.
The aortic root is the segment of the aorta between the left ventricular outflow tract and the sinotubular junction of the ascending aorta, and, on one level, is merely a tube, with a valve at its base, dynamic structures below it, and notable for having the life-limiting coronary arteries originate within its sinuses. However, we propose that the perception of the aortic root has been historically grossly over-simplified by virtue of a bias towards its internal aspect, in terms of coronary ostia and subvalvar relationships through the fibrous skeleton and in so-doing a myocardial component on the external aspect has all but been ignored. This myocardial mass, a component of the left ventricular free wall, is sometimes termed the 'left ostial process' but appears to be rarely, if ever, considered by anatomists, cardiologists, and surgeons alike. By virtue of its direct continuity to the aortic root and proximal left coronary artery, it may have unique roles and, at the very least, deserves greater recognition and investigation. Herein, we propose that it could play a crucial role in cardiac embryology including coronary dominance, and may afford a physiological advantage, to the extent that it may have been selected for in evolutionary terms.
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Belitsis et al. (2024) conducted a review in Aortic valve disease (prior to TAVI) (n=146). Left coronary artery dominance vs. Right coronary artery dominance was evaluated on Left main stem (LMS) length. In a retrospective review of 146 patients, shorter left main stem length (average 12 mm) was associated with left coronary artery dominance compared to right coronary artery dominance (average 14.06 mm).
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