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.
