Aortic root surgical anatomy
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The document discusses the surgical anatomy of the aortic root. It notes that the aortic root extends from the basal attachments of the aortic valve leaflets within the left ventricle to the sinutubular junction. The aortic root provides the supporting structures for the leaflets and is made up of the aortic valve sinuses along with intersinusal fibrous triangles and small crescents of ventricular muscle at its proximal end. The root is wider at the midpoint of the sinuses than at either end, and proper measurements of the root can only be taken at the bottom of the leaflet attachments, widest point of the sinuses, and sinutubular junction.
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Aortic root surgical anatomy
- 1. aortic root surgical anatomy dicky a wartono ,md Staff surgeon & aortic consultant national cardiovascular centre harapan kita Jakarta 2014
- 3. Surgical Anatomy of the Heart’, Cambridge University Press, Dr Benson Wilcox and Andrew Cook MMCTS 2007 (0102): : 02527 doi: 10.1510/mmcts.2006.002527 Heart 2000;84:670-673 doi:10.1136/heart.84.6.670
- 4. aortic root • Surgeons operating on the aortic root • The essence of the valvar complex is the semilunar attachments of the valvar leaflets. – extend from their basal attachments within the left ventricle to their distal attachments at the sinutubular junction • The extent of the leaflets defines the length of the root. – Within this length, the semilunar lines of attachments of the leaflets cross the anatomic ventriculo-aortic junction (circular line marking the transition from ventricular to arterial walls)
- 7. aortic root • outflow tract from the left ventricle, – provides the supporting structures for the leaflets of the aortic valve, • surrounding and supporting the leaflets, – extends from the basal attachments of the leaflets within the left ventricle to the sinutubular junction • its walls being made up of the aortic valvar sinuses – along with the interdigitating intersinusal fibrous triangles, and with two small crescents of ventricular muscle incorporated at its proximal end
- 21. Clinical implications • The root is much wider at the midpoint of the sinuses than at either the sinutubular junction or at the basal attachment of the leaflets, whilst the basal diameter can be up to one-fifth wider than the outlet at the sinutubular junction • Proper values can only be provided when measurements are made at the bottom of the valvar attachments, at the widest point of the sinuses, and also at the sinutubular junction
- 23. Thank You
Editor's Notes
- attitudinally correct orientation, the subpulmonary infundibulum has been transected, and the pulmonary valve removed, showing the central position of the aortic root within the cardiac short axis.
- The root extends from the basal attachments of the valvar leaflets within the ventricle (yellow arrows) to the sinutubular junction (red dotted line). The compass shows the orientation relative to the remaining thoracic organs.
- shows the extent of the aortic root, and reveals the semilunar attachments of the valvar leaflets supported by the right coronary and non-coronary aortic valvar sinuses. The red dotted line again shows the sinutubular junction, which is the distal extent of the root, whilst the red arrow shows the basal attachment of the right coronary aortic valvar leaflet, marking the proximal extent of the root. As shown by the yellow arrow, the anatomic ventriculo-aortic junction is in the middle part of the root, and is crossed by the hinge-lines of the valvar leaflets
- The cartoon shows a bisected aortic root, and illustrates how the semilunar attachment of the valvar leaflets incorporates aortic wall in the intersinusal triangles, and ventricular tissues at the base of each of the coronary aortic sinuses.
- The heart has been dissected by removing the atrial chambers and the arterial trunks, and is photographed from above, looking down on the atrioventricular and ventriculo-arterial junctions. It is orientated as it may be seen by the surgeon. The dissection shows how two of the aortic valvar sinuses (#1, #2) give rise to coronary arteries, and can be nominated as the left and right coronary aortic sinuses, respectively. The third sinus (#3) does not give rise to a coronary artery, and hence, is the non-coronary aortic sinus. Note again that the aortic valve forms the cardiac centrepiece.
- The aortic root has been opened from the front, and the leaflets of the aortic valve removed. The dissection shows how the interleaflet triangle between the non-coronary and left coronary aortic sinuses (purple dashed line) is part of the area of fibrous continuity with the aortic leaflet of the mitral valve. The red dotted line marks the anatomic ventriculo-aortic junction.
- The aortic root has been opened through a longitudinal incision across the area of aortic-mitral valvar continuity, and spread open to show the semilunar attachments of the valvar leaflets. Note the interleaflet triangles extending to the sinutubular junction, and the crescents of myocardium at the base of the two coronary aortic sinuses
- The heart is viewed from the right and behind, having pulled apart the aorta and the anterior atrial walls to show the transverse pericardial sinus. The interleaflet triangle between the non- and right coronary aortic sinuses has also been removed, showing how it communicates with the transverse sinus
- The heart has been opened through the right atrium and ventricle, and is viewed from the right side. The fibrous triangle between the non-coronary and right coronary aortic sinuses has been removed, showing how it abuts on the area of the membranous septum, but extends distally so as to be in potential communication with the pericardial cavity above the supraventricular crest of the right ventricle (yellow asterisks)
- This dissection has been made first by removing the free-standing subpulmonary infundibulum, and then by removing the triangle between the two coronary aortic sinuses. As can be seen, the tip of the triangle ‘points’ to the tissue plane between the back of the infundibulum and the aortic root.
- This section across one of the two coronary sinuses of the aortic valve shows how the hinge of the valvar leaflet is attached to the ventricular myocardium well proximal to the anatomic ventriculo-arterial junction
- The cartoon shows an idealised aortic root. The attachments of the valvar leaflets, shown in red, extend through the entire length of the root, from the sinutubular junction, in blue, to the virtual basal ring, shown in green, and produced by joining together the basal attachments of the leaflets. The crown-like attachments of the leaflets cross the anatomic ventriculo-aortic junction, shown in yellow.
- The cartoon shows how measurement of the basal ring provides information relating only to the entrance of the aortic root. To provide full details, measurements should be taken also of the diameter of the sinutubular junction, and at mid-sinusal level. None of these measurements take account of the diameter at the anatomic ventriculo-aortic junction.
- The cavities of the heart have been cast in blue for the right side, and red for the left side. As can be seen, when positioned in attitudinally appropriate fashion, the aortic root is posterior and to the right of the pulmonary valve.
- The cartoon shows the location of the atrioventricular conduction axis as it would be seen by the surgeon looking down through the aortic root.