Variants of the heart valves and syntopia of the nerves adiacent to the arch of aorta

Abstract

Introduction. The research topic is determined by the clinical significance of heart valves and the syntopy of the left vagus and left recurrent laryngeal nerves for several important reasons. Valve variants may mimic pathology on imaging, can lead to difficulties in right atrial catheterization and in the implantation of electrodes for cardiac resynchronization therapy, and may be confused echocardiographically with thrombi or vegetations. Damage to the nerves located in the region of the aortic arch occurs in 11–32% of surgical interventions, yet there is insufficient research on their variations. Materials and Methods. The macroscopic study included 50 adult hearts and aortas, museum exhibits from the Nicolae Testemitanu State University of Medicine and Pharmacy, and photographs of dissected cadavers from the department’s archive. Results. The following variants were detected: semilunar aortic valve perforation in 5%; presence of the Eustachian valve in 60% (66.6% as remnants, 26.6% pronounced, and an extended Chiari network in 6.6%); and the Thebesian valve in 70% (28.6% remnant, 22.8% cord-shaped, 25.7% semilunar, 5.7% fenestrated, 5.7% network-like, and 11.4% biconcave band). Syntopic variants of the left vagus nerve and the left recurrent laryngeal nerve that significantly differ from classical descriptions were identified. These nerves are at risk not only during surgical interventions on the aortic arch, but also during procedures involving the esophagus and trachea. Conclusions. 1. Structural variations of heart valves and the syntopy of the left vagus and left recurrent laryngeal nerves are common. Precise anatomical knowledge of these variations is required for endoscopic cardiac procedures and thoracic surgery. 2. The syntopy of the left vagus nerve and the left recurrent laryngeal nerve depends on the type of aortic arch branching, the location of its branches, and the constitutional body type. 3. Physicians’ awareness of organ variations is key to treatment success, as it helps prevent misdiagnosis, unnecessary interventions, and medico-legal errors.