The anatomy of the aortic root☆
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
References (8)
- et al.
The myth of the Aortic Annulus: the anatomy of the subaortic outflow tract
Ann. Thorac. Surg.
(1991) - et al.
Aortic root and valve relationship. Impact on surgical repair
J. Thorac. Cardiovasc. Surg.
(1994) - et al.
Functional anatomy, pp. 609–629
(1994) - et al.
The forgotten interleaflet triangles: a review of surgical anatomy of the aortic valve
Ann. Thorac. Surg.
(1995)
Cited by (0)
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Presented at the 50th International Congress of the European Society for Cardiovascular Surgery, 20–23 June 2001, Budapest, Hungary.