Abstract
Although the morphology of the aortic root has been well investigated by anatomists and pathologists, they have not always described its features according to the basic rule of anatomy, namely that structures should be described as seen within the body, that is in attitudinally appropriate fashion. It is now possible to show the features in this way using multidetector-row computed tomography. This technique, permitting virtual dissection of the obtained datasets, now provides the gold standard for appreciating the nuances of the anatomy of the root.
It extends from the virtual basal ring, formed by joining together the basal attachments of the semilunar leaflets, to the sinotubular junction, this being the ring at which the distal attachments of the leaflets come together at the periphery of the valvar orifice. It is the virtual basal ring that is identified by echocardiographers as the “annulus”, whereas many surgeons take the semilunar hinges of the leaflets to represent the “annulus”. Separating the ventricular aspects of the semilunar valvar hinges are the interleaflet triangles. Within the length of the root is found the anatomic ventriculo-arterial junction, where the arterial walls of the sinuses are supported by the musculature of the ventricular mass. This junction, however, is found only in the two valvar sinuses that give rise to the coronary arteries, since the non-adjacent leaflet of the aortic valve, along with half of the left coronary aortic leaflet, is in fibrous continuity with the aortic leaflet of the mitral valve.
In this chapter, we described the detailed anatomy of the fibrous interleaflet triangles, emphasising their significance in the setting of the overall anatomy of the aortic root. We also discuss the anatomy as revealed by interrogation of the datasets provided by multidetector-row computed tomography in the light of the measurements of the root usually made by echocardiographers.
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Mori, S., Spicer, D.E., Anderson, R.H. (2018). Living 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_3
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DOI: https://doi.org/10.1007/978-3-319-74213-7_3
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