Surgical anatomy of the aortic valve and root-implications for valve repair

被引:23
作者
De Paulis, Ruggero [1 ]
Salica, Andrea [1 ]
机构
[1] European Hosp, Dept Cardiac Surg, Via Portuense 700, I-00149 Rome, Italy
关键词
Aortic root; aortic valve; valve sparing; valve repair; anatomy; RE-CREATION; SINUSES; ANNULUS; FLOW; MECHANISM; VALSALVA; LEAFLETS; STRESS;
D O I
10.21037/acs.2019.04.16
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The aortic root is an important anatomical structure positioned at the center of the heart, making it critical to the functioning of the major cardiac chambers. Deep knowledge of the anatomical "surroundings" of the aortic root is crucial for surgeon attempting to spare or repair a leaking aortic valve. In fact, root dissection is a necessary step to "skeletonize" the aortic valve, allowing the surgeon to work on the critical components of its structure, namely the aorto-ventricular junction, the virtual basal ring (VBR) and the sino-tubular junction (STJ). These three components, along with the insertion of the leaflet to the aortic wall, form the skeleton of the aortic valve that is essential in guaranteeing valve competence. A good anatomical proportion between the various component of the skeleton of the aortic valve need to be verified, or re-established in order to set the basis for an optimal aortic valve repair. Once the skeleton of the heart has been correctly addressed, the condition of the valve leaflets need to be considered. Excess of leaflet tissue is treated by leaflet plication or resection and lack of leaflet tissue is addressed by tissue extension with autologous or heterologous materials. In the present manuscript, we highlight the principal structure of the aortic root and describe in detail each anatomical component. This basic anatomical knowledge is also important for a through understanding of the normal function of the valve and root structure during the cardiac cycle. The close boundaries existing between the left ventricular cavity and the aorta are important in explaining the sophisticated function of opening and closing of the aortic valve. Similarly, the role played by the sinuses of Valsalva in regulating the blood flow exiting the ventricle underline the concept that "form follows function" and emphasizes the importance of a good anatomical reconstruction for an optimal and long-lasting valve function.
引用
收藏
页码:313 / 321
页数:9
相关论文
共 33 条
[1]   THE MYTH OF THE AORTIC ANNULUS - THE ANATOMY OF THE SUBAORTIC OUTFLOW TRACT [J].
ANDERSON, RH ;
DEVINE, WA ;
SIEW, YH ;
SMITH, A ;
MCKAY, R .
ANNALS OF THORACIC SURGERY, 1991, 52 (03) :640-646
[2]  
Anderson RH, 2007, MULTIMED MAN CARDIOT, V2007
[3]  
Anderson RH, 2018, EUR J CARDIOTHORAC S
[4]   MECHANISM OF CLOSURE OF AORTIC VALVE [J].
BELLHOUSE, BJ ;
BELLHOUSE, FH .
NATURE, 1968, 217 (5123) :86-+
[5]   The anatomy of the aortic root [J].
Berdajs, D ;
Lajos, P ;
Turina, M .
CARDIOVASCULAR SURGERY, 2002, 10 (04) :320-327
[6]   Conformational Pulsatile Changes of the Aortic Annulus Impact on Prosthesis Sizing by Computed Tomography for Transcatheter Aortic Valve Replacement [J].
Blanke, Philipp ;
Russe, Maximillian ;
Leipsic, Jonathon ;
Reinoehl, Jochen ;
Ebersberger, Ullrich ;
Suranyi, Pal ;
Siepe, Matthias ;
Pache, Gregor ;
Langer, Mathias ;
Schoepf, U. Joseph .
JACC-CARDIOVASCULAR INTERVENTIONS, 2012, 5 (09) :984-994
[7]  
Chirichilli I, 2019, EUR J CARDIOTHORAC S
[8]  
Choo SJ, 1999, J HEART VALVE DIS, V8, P407
[9]   Attitudinally correct nomenclature [J].
Cook, AC ;
Anderson, RH .
HEART, 2002, 87 (06) :503-506
[10]   A three-dimensional computational analysis of fluid-structure interaction in the aortic valve [J].
De Hart, J ;
Peters, GWM ;
Schreurs, PJG ;
Baaijens, FPT .
JOURNAL OF BIOMECHANICS, 2003, 36 (01) :103-112