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
Muresian H. The clinical anatomy of the right ventricle. Clin Anat. 2016;29:380–98.
Muresian H. The Ross procedure: new insights into the surgical anatomy. Ann Thorac Surg. 2006;81:495–501.
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.
Anderson RH. Clinical anatomy of the aortic root. Heart. 2000;84:670–3.
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.
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.
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.
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.
Berdajs D, Kunzli A, Shurr U, et al. Clinical anatomy of the atrioventricular node artery. J Heart Valve Dis. 2006;15:225–9.
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.
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.
Lansac E, Lim HS, Shomura Y, et al. Aortic root dynamics are asymmetric. J Heart Valve Dis. 2005;14:400–7.
Berdajs D, Lajos P, Turina M. The anatomy of the aortic root. Cardiovasc Surg. 2002;10:320–7.
Anderson RH. Defining the enigmatic annulus of the aortic valve. Eur J Cardiothorac Surg. 2016;49:101–2.
Angelini A, Thiene G, Anderson RH. Anatomy of the mitral valve. New York: Futura; 2000.
Okazaki Y, Takarabe K, Furukawa K, et al. Distensibility of the pulmonary autograft under systemic pressure. J Heart Valve Dis. 2002;11:231–5.
David TE. Aortic valve sparing operations: a review. Korean J Thorac Cardiovasc Surg. 2012;45:205–12.
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.
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.
Anderson RH, Loukas M. The importance of attitudinally appropriate description of cardiac anatomy. Clin Anat. 2009;22:47–51.
Nicks R, Cartmill T, Bernstein L. Hypoplasia of the aortic root. The problem of aortic valve replacement. Thorax. 1970;25:339–46.
Manouguian S, Kirchhoff PG. Aortic and aortic-mitral annular enlargement. J Thorac Cardiovasc Surg. 1996;112:207.
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.
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.
Timek TA, Green GR, Tibayan FA, et al. Aorto-mitral annular dynamics. Ann Thorac Surg. 2003;76:1944–50.
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.
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.
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.
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.
Yuan SM. The anatomopathology of bicuspid aortic valve. Folia Morphol (Warsz). 2011;70:217–27.
Mordi I, Tzemos N. Bicuspid aortic valve disease: a comprehensive review. Cardiol Res Pract. 2012;2012:196037.
Sievers HH, Schmidtke C. A classification system for the bicuspid aortic valve from 304 surgical specimens. J Thorac Cardiovasc Surg. 2007;133:1226–33.
Waller BF, Carter JB, Williams HJ Jr, et al. Bicuspid aortic valve. Comparison of congenital and acquired types. Circulation. 1973;48:1140–50.
Yuan SM, Jing H, Lavee J. The bicuspid aortic valve and its relation to aortic dilation. Clinics (Sao Paulo). 2010;65:497–505.
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.
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.
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.
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.
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.
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.
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.
Siu SC, Silversides CK. Bicuspid aortic valve disease. J Am Coll Cardiol. 2010;55:2789–800.
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.
Hurwitz LE, Roberts WC. Quadricuspid semilunar valve. Am J Cardiol. 1973;31:623–6.
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.
Timperley J, Milner R, Marshall AJ, et al. Quadricuspid aortic valves. Clin Cardiol. 2002;25:548–52.
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.
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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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