The aortic root

  • Charles A. Yankah
  • M. Pasic
  • E. Ivanitskaia-Kühn
  • Jörg Kempfert
  • Thomas Walther
  • Friedrich-Wilhelm Mohr
  • Roland Hetzer


The shape of the aortic valve leaflet was first described by Philiston [1] in the 4th century BC as semilunar, and in 1513 Leonardo da Vinci [3] depicted in a drawing the geometry of the orifice of an opened and closed aortic valve as triangular and with three adjacent hemispherical forms, respectively (Figs. 13). Valsalva described the aortic sinuses in 1740 and suggested that the coronary artery filling takes place in the sinuses during diastole [4]. Recent echocardiographic and computed tomographic descriptions of the aortic valve and root diseases [5, 6, 7] and their relationship to the coronary artery origins have documented the importance of imaging the aortic root and the impact on the technical artistry of aortic root replacement, valve-sparing surgery, and minimally invasive transcatheter aortic valve replacement (Figs. 47) [8, 9, 10, 11, 12]. In fact, 2.9% of adults older than 65 years have calcific aortic stenosis [7].
Fig. 1.

Echocardiographic imaging of the aortic root: short and long axis view. a Short axis view: severe AS: AVA 0.5 cm2; b long axis view: aortic valve annulus ∅ 24 mm; c mild mitral regurgitation, moderate tricuspid regurgitation

Fig. 2.

Cardiac computed tomographic view of the aortic root: end-systolic phase. The anatomic relationship between the aortic annulus and the coronary artery are shown

Fig. 3.

a The aortic valve in systole. b Opened leaflets in a triangular configuration. c The aortic valve in diastole in a configuration of three adjacent hemispheric form

Fig. 4.

Cardiac computed tomographic view of the aortic root. a Annulus 26 mm, b distance to left main coronary artery: 16 mm, c distance to RCA 16 mm

Fig. 5.

a The Edwards Sapien transcatheter self-expandable pericardial valve. b Transapical implantation of the Edwards Sapien self-expandable sutureless pericardial valve in the aortic root

Fig. 6.

Transapical valve-in-valve implantation of Edwards Sapien valve in a bioprosthesis after structural valve deterioration. a Introduction of the unexpanded Edwards Sapien valve into the bioprosthesis after balloon dilatation. b Implanted self-expandable Edwards Sapien valve in the bioprosthesis

Fig. 7.

Synopsis of a symptomatic aortic stenosis for transcatheter aortic valve replacement (AVA aortic valve area, STS Society of Thoracic Surgeons, TEE transesophageal echocardiography, CT computed tomography, AVR aortic valve replacement, TAVR transapical aortic valve replacement, TFAVR transfemoral aortic valve replacement)


Aortic Valve Aortic Root Transcatheter Aortic Valve Replacement Aortic Annulus Aortic Valve Leaflet 
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  1. 1.
    Leboucq G (1944) Une anatomie antique du Coeur human. Philiston de Locroi et le timee’ de Plation. Rev Grecques 57:7Google Scholar
  2. 2.
    Sarton G (1952) A history of science. I Ancient science through the golden age of Greece. Harvard University Press, Cambridge, MassachusettsGoogle Scholar
  3. 3.
    Leonardo da Vinci (1977) Anatomical drawings from the Royal collections. The Royal Academy of Arts, London, p 35AGoogle Scholar
  4. 4.
    Valsalva AM (1740) Arteria magnae sinus. In: Morgagni JB (ed) Opera, pp 1–129Google Scholar
  5. 5.
    Siniawski H, Lehmkuhl H, Weng Y, Pasic M, Yankah C, Hoffman M, Behnke I, Hetzer R (2003) Stentless aortic valves as an alternative to homografts for valve replacement in active infective endocarditis complicated by ring abscess. Ann Thorac Surg 75:803–808CrossRefPubMedGoogle Scholar
  6. 6.
    American College of Cardiology; American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease); Society of Cardiovascular Anesthesiologists, Bonow RO, Carabello BA, Chatterjee K, de Leon AC Jr, Faxon DP, Freed MD et al (2006) ACC/AHA 2006 guidelines for the management of patients with valvular heart disease. Circulation 114:e84–e231CrossRefPubMedGoogle Scholar
  7. 7.
    Otto CM, Lind BK, Kitzman DW, Gersh BJ, Siscovick DS (1999) Association of aortic valve sclerosis with cardiovascular mortality and morbidity in the elderly. N Engl J Med 341:142–147CrossRefPubMedGoogle Scholar
  8. 8.
    Walther T, Simon P, Dewey T, Wimmer-Greinecker G, Falk V, Kasimir MT, Doss M, Borger M, Schuler G, Glogar D, Fehske W, Wolner E, Mohr F, Mack M (2007) Transapical minimally invasive aortic valve implantation. Multicenter experience. Circulation 116(Suppl I):I240–I245PubMedGoogle Scholar
  9. 9.
    Walther T, Dewey T, Borger M, Kempfert J, Linke A, Becht R, Falk V, Schuler G, Mohr F, Mack M (2008) Human minimally invasive off-pump valve-in-valve implantation: Step by step. Ann Thorac Surg 85:1072–1073CrossRefPubMedGoogle Scholar
  10. 10.
    Grube E, Schuler G, Blumenthal L et al (2007) Percutaneous aortic valve replacement for severe aortic stenosis in high risk patients using the second-and current third-generation self-expanding CoreValve prosthesis: device success and 30-day clinical outcome. J Am Coll Cardiol 50:69–76CrossRefPubMedGoogle Scholar
  11. 11.
    Webb JG, Chandavimol M, Thompson CR et al (2006) Percutaneous aortic valve implantation retrograde from the femoral artery. Circulation 113:842–850CrossRefPubMedGoogle Scholar
  12. 12.
    Lieberman EB, Bashore TM et al (1995) Balloon aortic valvuloplasty in adults. Failure of procedure to improve long-term survival. J Amer Coll Cardiol 26:1522–1528CrossRefGoogle Scholar
  13. 13.
    Bentall H, De Bono A (1968) A technique for complete replacement of the ascending aorta. Thorax 23:338–339CrossRefPubMedGoogle Scholar
  14. 14.
    Petrou M, Wong K, Albertucci M, Brecker SJ, Yacoub MH (1994) Evaluation of unstented aortic homografts for the treatment of prosthetic aortic valve endocarditis. Circulation 90(Part 2):II-198–II-204Google Scholar
  15. 15.
    Yankah AC, Pasic M, Klose H, Siniawski H, Weng Y, Hetzer R (2005) Homograft reconstruction of the aortic root for endocarditis with periannular abscess: a 17-year study. Eur J Cardiothorac Surg 28:69–75CrossRefPubMedGoogle Scholar
  16. 16.
    Yankah AC, Sievers HH, Buersch JH, Radtcke W, Lange PE, Heintzen PH, Bernhard A (1984) Orthotopic transplantation of aortic valve allograft. Early hemodynamic results. Thorac Cardiovasc Surgeon 32:92–95CrossRefGoogle Scholar
  17. 17.
    Mogovern GJ, Kent EM, Cromie HW (1962) Sutureless artificial heart valves. Circulation 27:2784–2788Google Scholar
  18. 18.
    Zlotnick AY, Shiran A, Lewis BS, Aravot D (2008) A perfectly functioning Magovern-Cromie sutureless prosthetic aortic valve 42 years after implantation. Circulation 117:e1–e2CrossRefPubMedGoogle Scholar
  19. 19.
    Walther T, Dewey T, Borger M, Kempfert J, Linke A, Becht R, Falk V, Schuler G, Mohr F, Mack M (2009) Transapical aortic valve implantation: Step by step. Ann Thorac Surg 87:276–283CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2010

Authors and Affiliations

  • Charles A. Yankah
    • 1
  • M. Pasic
  • E. Ivanitskaia-Kühn
  • Jörg Kempfert
    • 2
  • Thomas Walther
    • 2
  • Friedrich-Wilhelm Mohr
    • 2
  • Roland Hetzer
    • 1
  1. 1.Deutsches Herzzentrum Berlin & Charité Medical University BerlinBerlinGermany
  2. 2.Herzzentrum Klinik für HerzchirurgieUniversität LeipzigLeipzigGermany

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