Elsevier

Cardiovascular Surgery

Volume 10, Issue 4, August 2002, Pages 320-327
Cardiovascular Surgery

The anatomy of the aortic root

https://doi.org/10.1016/S0967-2109(02)00018-2Get rights and content

Abstract

Objective: Since the aortic root preserving methods are spreading in heart surgery, the importance of aortic root anatomy is increasing. The surgical and anatomical descriptions of the aortic root are not always congruent. Therefore, the present study focuses on the surgical aspects of the aortic root anatomy.

Methods: We measured the distances between the three commissures, the distances between the basal point of the sinus and the sinotubular junction and the heights of the sinuses. The circumference of the sinotubular junction and the annuli fibrosi were also obtained. In addition, the volume of every sinus was directly measured. Finally both vertical and horizontal histological sections of annuli fibrosi were made.

Results: All measured parameters were averaged and the standard deviation (SD) was calculated, except in the case of the tilt angle. The distance for the right sinus commissures was 18.82 mm (SD 1.93 mm), and that of the non- and left coronary sinus were 17.43 (SD 2.06) and 15.21 (SD 1.88) mm, respectively. The mean height of the right, non- and left coronary sinus were 19.45 (SD 1.91), 17.68 (SD 1.77) and 17.45 (SD 1.39) mm, respectively. These differences between the height of the sinuses determines a mean tilt angle of 5.47° for the sinotubular junction and aortic root base. The mean circumference of the aortic root base and of the sinotubular junction was 69.20 (SD 6.93), and 65.82 (SD 8.31) mm, respectively. Mean volumes of the right, non- and left coronary sinuses were 1.6 (SD 0.34), 1.33 (SD 0.27) and 1.04 (SD 0.23l) ml. According to the histological sections we can say that the histological border of the annuli fibrosi is positioned at the interleaflate triangles.

Conclusion: According to the measured data we can state that all parameters follow the pattern in which the right sinus structures had the greatest dimensions followed by the non coronary sinus, and finally the left coronary sinus. The tilt angle for aortic root base and sinotubular junction, and the difference in the diameters could be of hemodynamic and of surgical relevance

Introduction

The aortic root is ordinarily presented as a structure which is bordered superiorly by the sinutubular ridge and inferiorly by the aortic root base and comprises three similar leaflets, three sinuses of Valsava, intervalvular triangles and the origins of the coronary arteries. According to the anatomical literature [1] the annulus fibrosus is defined as the border line at the level of the aortoventricular transition. This simplified and irregular description of the aortic root is no longer tenable at the time when the aortic root preserving methods, aortic valve conservations and annuloplasty are becoming increasingly important. During the description of the correct anatomy of the aortic root it was reported by different authors that the structures into the aortic root are not of similar dimensions. However, these differences were considered to be small, random and insignificant [2], [3], [4].

Our aim was to determine where the microscopical and macroscopical positions of the annulus fibrosus are, whether the differences between the parameters of the leaflets and sinuses are random or whether they follow a certain pattern. In order to obtain an accurate anatomy of the aortic root, different microscopical and macroscopical methods were introduced.

Section snippets

Material and methods

The aortic roots of 25 hearts were included in our study. The aortic roots were without any structural and anatomical abnormalities. When removing the hearts from the cadavers, the ascending aorta was transected immediately proximal to the brachiocephalic artery. The surrounding tissue, the bifurcation of the pulmonary trunk and its proximal part were trimmed away. A 4% formaldehyde solution was injected into the aortic root and as a consequence the valves were closed and the sinuses were

Results

Non-parametric analysis of variance was conducted on the intercommissural distance, on the height of the sinuses, and on the dimensions of the sinus volume. The mean values and standard deviations (SDs) were calculated.

The linear distances between the commissures, their mean values and SDs are shown in Table 1. The mean linear distance of the right sinus commissures was 18.82 (SD 1.93) mm, and that of the non- and left coronary sinus were 17.43 (SD 2.06) and 15.21 (SD 1.88) mm, respectively (

Conclusions and discussion

Developments of new surgical methods always demand a review of the corresponding anatomical knowledge. This review sometimes encounters incompleteness of the descriptions, which prompts a more detailed study of the operating area.

Since new methods were invented in aortic root surgery, there is a continuing battle between the physiologists, the surgeons and the morphologists for the most appropriate terminology to describe the anatomy of the aortic root. The aortic root is defined as the

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Presented at the 50th International Congress of the European Society for Cardiovascular Surgery, 20–23 June 2001, Budapest, Hungary.

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