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Clinical and Surgical Anatomy of the Aortic Root

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Aortic Regurgitation

Abstract

The arterial (aortic and pulmonary) roots, although apparently of a simpler design, as compared with the atrioventricular valves, depict a more refined, more subtle and still less understood structure and function. The aortic root is constituted of interdependent elements: the sinuses, the leaflets, the interleaflet triangles, the sinotubular junction and additional “annuluses”, and lodges the origin of the coronary arteries. The normal gross anatomy , histology and physiology of the aortic root are synthetically described in order to underscore the importance of a thorough diagnostic interrogation while also presenting some limits of the standard measurements. The characteristics of the diseased aortic root are subsequently described offering a useful guide for a complete and clinically and surgically relevant diagnostic picture, for elaborating the most suited therapeutic indication in the individual patient and for the best and most accurate surgical procedure to be applied.

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References

  1. Muresian H. The clinical anatomy of the right ventricle. Clin Anat. 2016;29:380–98.

    Article  PubMed  Google Scholar 

  2. Muresian H. The Ross procedure: new insights into the surgical anatomy. Ann Thorac Surg. 2006;81:495–501.

    Article  PubMed  Google Scholar 

  3. Cheng A, Dagum P, Miller DC. Aortic root dynamics and surgery: from craft to science. Philos Trans R Soc Lond B Biol Sci. 2007;362:1407–19.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Anderson RH. Clinical anatomy of the aortic root. Heart. 2000;84:670–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Hokken RB, Bartelings MM, Bogers AJ, et al. Morphology of the pulmonary and aortic roots with regard to the pulmonary autograft procedure. J Thorac Cardiovasc Surg. 1997;113:453–61.

    Article  CAS  PubMed  Google Scholar 

  6. Gittenberger-de Groot AC, Sauer U, Oppenheimer-Dekker A, et al. Coronary arterial anatomy in transposition of the great arteries: a morphological study. Pediatr Cardiol. 1983;4:15–24.

    Google Scholar 

  7. Sutton JP 3rd, Ho SY, Anderson RH. The forgotten interleaflet triangles: a review of the surgical anatomy of the aortic valve. Ann Thorac Surg. 1995;59:419–27.

    Article  PubMed  Google Scholar 

  8. David TE, Feindel CM. An aortic valve-sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta. J Thorac Cardiovasc Surg. 1992;103:617–21; discussion 622.

    CAS  PubMed  Google Scholar 

  9. Berdajs D, Kunzli A, Shurr U, et al. Clinical anatomy of the atrioventricular node artery. J Heart Valve Dis. 2006;15:225–9.

    PubMed  Google Scholar 

  10. Berdajs D, Schurr UP, Wagner A, et al. Incidence and pathophysiology of atrioventricular block following mitral valve replacement and ring annuloplasty. Eur J Cardiothorac Surg. 2008;34:55–61.

    Article  PubMed  Google Scholar 

  11. Anderson RH, Cook AJ, Hlavacek J, et al. Normal cardiac anatomy. In: da Cruz EM, et al., editors. Pediatric and congenital cardiology, cardiac surgery and intensive care. London: Springer; 2014. p. 17–46.

    Chapter  Google Scholar 

  12. Lansac E, Lim HS, Shomura Y, et al. Aortic root dynamics are asymmetric. J Heart Valve Dis. 2005;14:400–7.

    PubMed  Google Scholar 

  13. Berdajs D, Lajos P, Turina M. The anatomy of the aortic root. Cardiovasc Surg. 2002;10:320–7.

    Article  PubMed  Google Scholar 

  14. Anderson RH. Defining the enigmatic annulus of the aortic valve. Eur J Cardiothorac Surg. 2016;49:101–2.

    Article  PubMed  Google Scholar 

  15. Angelini A, Thiene G, Anderson RH. Anatomy of the mitral valve. New York: Futura; 2000.

    Google Scholar 

  16. Okazaki Y, Takarabe K, Furukawa K, et al. Distensibility of the pulmonary autograft under systemic pressure. J Heart Valve Dis. 2002;11:231–5.

    PubMed  Google Scholar 

  17. David TE. Aortic valve sparing operations: a review. Korean J Thorac Cardiovasc Surg. 2012;45:205–12.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Weltert L, de Tullio MD, Afferrante L, et al. Annular dilatation and loss of sino-tubular junction in aneurysmatic aorta: implications on leaflet quality at the time of surgery. A finite element study. Interact Cardiovasc Thorac Surg. 2013;17:8–12.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Davies RR, Gallo A, Coady MA, et al. Novel measurement of relative aortic size predicts rupture of thoracic aortic aneurysms. Ann Thorac Surg. 2006;81:169–77.

    Article  PubMed  Google Scholar 

  20. Anderson RH, Loukas M. The importance of attitudinally appropriate description of cardiac anatomy. Clin Anat. 2009;22:47–51.

    Article  PubMed  Google Scholar 

  21. Nicks R, Cartmill T, Bernstein L. Hypoplasia of the aortic root. The problem of aortic valve replacement. Thorax. 1970;25:339–46.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Manouguian S, Kirchhoff PG. Aortic and aortic-mitral annular enlargement. J Thorac Cardiovasc Surg. 1996;112:207.

    Article  CAS  PubMed  Google Scholar 

  23. Erez E, Kanter KR, Tam VK, et al. Konno aortoventriculoplasty in children and adolescents: from prosthetic valves to the Ross operation. Ann Thorac Surg. 2002;74:122–6.

    Article  PubMed  Google Scholar 

  24. Muresian H. The vascularization of particular cardiac areas, in The clinical anatomy of the coronary arteries. An anatomical study on 100 human heart specimens. 2009, Ed. Enciclopedica. p. 155–7.

    Google Scholar 

  25. Timek TA, Green GR, Tibayan FA, et al. Aorto-mitral annular dynamics. Ann Thorac Surg. 2003;76:1944–50.

    Article  PubMed  Google Scholar 

  26. Aybek T, Sotiriou M, Wohleke T, et al. Valve opening and closing dynamics after different aortic valve-sparing operations. J Heart Valve Dis. 2005;14:114–20.

    PubMed  Google Scholar 

  27. Leyh RG, Schmidtke C, Sievers HH, et al. Opening and closing characteristics of the aortic valve after different types of valve-preserving surgery. Circulation. 1999;100:2153–60.

    Article  CAS  PubMed  Google Scholar 

  28. Leyh RG, Kallenbach K, Karck M, et al. Impact of preoperative aortic root diameter on long-term aortic valve function after valve sparing aortic root reimplantation. Circulation. 2003;108(Suppl 1):II285–90.

    PubMed  Google Scholar 

  29. Roberts WC, Ko JM. Frequency by decades of unicuspid, bicuspid, and tricuspid aortic valves in adults having isolated aortic valve replacement for aortic stenosis, with or without associated aortic regurgitation. Circulation. 2005;111:920–5.

    Article  PubMed  Google Scholar 

  30. Yuan SM. The anatomopathology of bicuspid aortic valve. Folia Morphol (Warsz). 2011;70:217–27.

    Google Scholar 

  31. Mordi I, Tzemos N. Bicuspid aortic valve disease: a comprehensive review. Cardiol Res Pract. 2012;2012:196037.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Sievers HH, Schmidtke C. A classification system for the bicuspid aortic valve from 304 surgical specimens. J Thorac Cardiovasc Surg. 2007;133:1226–33.

    Article  PubMed  Google Scholar 

  33. Waller BF, Carter JB, Williams HJ Jr, et al. Bicuspid aortic valve. Comparison of congenital and acquired types. Circulation. 1973;48:1140–50.

    Article  CAS  PubMed  Google Scholar 

  34. Yuan SM, Jing H, Lavee J. The bicuspid aortic valve and its relation to aortic dilation. Clinics (Sao Paulo). 2010;65:497–505.

    Article  Google Scholar 

  35. Schaefer BM, Lewin MB, Stout KK, et al. The bicuspid aortic valve: an integrated phenotypic classification of leaflet morphology and aortic root shape. Heart. 2008;94:1634–8.

    Article  CAS  PubMed  Google Scholar 

  36. Angelini A, Ho SY, Anderson RH, et al. The morphology of the normal aortic valve as compared with the aortic valve having two leaflets. J Thorac Cardiovasc Surg. 1989;98:362–7.

    CAS  PubMed  Google Scholar 

  37. Michelena HI, Desjardins VA, Avierinos JF, et al. Natural history of asymptomatic patients with normally functioning or minimally dysfunctional bicuspid aortic valve in the community. Circulation. 2008;117:2776–84.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Robicsek F, Thubrikar MJ, Cook JW, et al. The congenitally bicuspid aortic valve: how does it function? Why does it fail? Ann Thorac Surg. 2004;77:177–85.

    Article  PubMed  Google Scholar 

  39. Keane MG, Wiegers SE, Plappert T, et al. Bicuspid aortic valves are associated with aortic dilatation out of proportion to coexistent valvular lesions. Circulation. 2000;102:III35–9.

    Article  CAS  PubMed  Google Scholar 

  40. Ferencik M, Pape LA. Changes in size of ascending aorta and aortic valve function with time in patients with congenitally bicuspid aortic valves. Am J Cardiol. 2003;92:43–6.

    Article  PubMed  Google Scholar 

  41. Gurvitz M, Chang RK, Drant S, et al. Frequency of aortic root dilation in children with a bicuspid aortic valve. Am J Cardiol. 2004;94:1337–40.

    Article  PubMed  Google Scholar 

  42. Siu SC, Silversides CK. Bicuspid aortic valve disease. J Am Coll Cardiol. 2010;55:2789–800.

    Article  PubMed  Google Scholar 

  43. Tang YF, Xu JB, Han L, et al. Congenital quadricuspid aortic valve: analysis of 11 surgical cases. Chin Med J (Engl). 2011;124:2779–81.

    Google Scholar 

  44. Hurwitz LE, Roberts WC. Quadricuspid semilunar valve. Am J Cardiol. 1973;31:623–6.

    Article  CAS  PubMed  Google Scholar 

  45. Bogers AJ, Gittenberger-de Groot AC, Poelmann RE, et al. Development of the origin of the coronary arteries, a matter of ingrowth or outgrowth? Anat Embryol (Berl). 1989;180:437–41.

    Article  CAS  Google Scholar 

  46. Timperley J, Milner R, Marshall AJ, et al. Quadricuspid aortic valves. Clin Cardiol. 2002;25:548–52.

    Article  PubMed  Google Scholar 

  47. Singh S, Ghayal P, Mathur A, et al. Unicuspid unicommissural aortic valve: an extremely rare congenital anomaly. Tex Heart Inst J. 2015;42:273–6.

    Article  PubMed  PubMed Central  Google Scholar 

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Author information

Authors and Affiliations

  1. Cardiovascular Surgery, University Hospital of Bucharest, Bucharest, Romania

    Horia Muresian M.D., Ph.D.

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  1. Horia Muresian M.D., Ph.D.
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Editors and Affiliations

  1. Department of Cardiac Surgery, Charles University in Prague, Hradec Kralove, Czech Republic

    Jan Vojacek

  2. Department of Cardiac Surgery, Charles University in Prague, Hradec Kralove, Czech Republic

    Pavel Zacek

  3. Department of Cardiac Surgery, Charles University in Prague, Hradec Kralove, Czech Republic

    Jan Dominik

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Muresian, H. (2018). Clinical and Surgical Anatomy of the Aortic Root. In: Vojacek, J., Zacek, P., Dominik, J. (eds) Aortic Regurgitation. Springer, Cham. https://doi.org/10.1007/978-3-319-74213-7_2

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  • DOI: https://doi.org/10.1007/978-3-319-74213-7_2

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-74212-0

  • Online ISBN: 978-3-319-74213-7

  • eBook Packages: MedicineMedicine (R0)

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