The document summarizes the anatomy of the aortic valve and root. It describes the location at the junction of the left ventricle and ascending aorta. The aortic valve has three cusps - the right coronary, left coronary, and posterior cusps. Behind each cusp is an aortic sinus of Valsalva from which the coronary arteries arise. Echocardiography can be used to visualize the aortic root and cusps in both 2D and 3D. Various echocardiographic views like parasternal long and short axis are used to assess aortic root anatomy and valve function.

1. ECHO MEET
AORTIC VALVE & ROOT ANATOMY

2. INTRODUCTION
 located at the junction of LV outflow tract and ascending Aorta.
 annulus, cusp and commissure
 3 cusp –
 anterior wall(right coronary cusp)
 posterior wall(left and posterior cusp)
 Cusp - fold of endocardium with central fibrous core.
 Each cusp
 thick basal border
 deeply concave on its aortic aspects and horizontal free margins.

3.  Behind each cusp aortic wall bulges to form aortic sinus of valsava.
 Coronary arteries arise form the sinus
 Commisures - tall peacked space between the attachment of
adjacent cusp and attain the level of aortic sinotubular junction


4. •
Aortic Root - Anatomy

5. 
Histology:
fibrous continuity with the anterior
leaflet of the mitral valve and the
membranous septum;
connective tissue (fibrous strands)
unites the aortic root to the
interventricular septum.

6. They are attached to the aortic root in a semilunar fashion
Valve Leaflets
triangular space underneath the leaflet (trigone) is
part of the left ventricle.
highest point of the trigone where the leaflets meet
=commissure
commissures are localised immediately below the
Sinotubular Junction.
2 trigones underneath the commissures of the
noncoronary leaflet are fibrous structures
other underneath the commissure between the right
and the left leaflets is mostly a muscular structure.

7. Sinuses of Valsalva
leaflet proximally
sinotubular junction distally
3 elliptical inlets
• Guaranteeing coronary artery
perfusion during systole
• Creating eddies to close the
aortic leaflets during diastole

8. terminal edge of the aortic root
imaginary line that connects together the 3 commissures.
Young
adults
AA>STJ
Adults
AA =
STJ
Elderly
AA<STJ
BASE = Aortic Annulus (AA)
Sinotubular Junction

9. Anatomic and Echocardiographic Relationship
Between the Components of the Normal Aortic Root
Systole
Diastole
120 degree - LAX
ST junctionAnnulus
Tubular aortaSinuses

10. TRANSTHORASIC
ECHOCARDIOGRAPHY

11. PARASTERNAL LONGAXIS (PLAX )

12.  linear thin lines, parallel and close to the walls of the aortic root .
 right cusp lies anteriorly
 either non-coronary or left coronary leaflets =posteriorly
 cusp coaptation occurs at a level corresponding to the middle of
the sinuses of Valsalva, i.e. halfway between the ventriculo-aortic
junction and the sinotubular junction.
 measurements of the left ventricular outflow tract/aortic annulus
 aortic root diameters at various levels

13.  antero-posterior diameter of the aortic annulus hinge points
of the aortic valve cusps (inner edge - inner edge) during
mid-systole when the annulus reaches its largest size.
 aortic root diameter at the level of Valsalva sinuses
=largest, followed by the sinotubular junction and the aortic
annulus.

18. PARASTERNAL SHORT AXIS

19.  en face as seen from the left ventricle
 three cusps open symmetrically and form a circular or triangular
orifice during systole
 during diastole=Y” sign with equal space between the 3 commissures.
 number of cusps
 integrity of cusps and commissures
 normal origin of coronary arteries
 bicuspid and a tricuspid aortic valve =during systole, since a raphe
between 2 fused cusps of a bicuspid valve is indistinguishable from a
normal commissure of a tricuspid valve when the valve is closed
during diastole.

27. M MODE

31. APICAL VIEW

33. DOPPLER STUDY

35. SUB COSTAL VEIW

37. TRANS OESOPHAGEAL VEIW

38.  detailed assessment is required (surgical or procedural
planning, suspected infective endocarditis etc),
 long- and short-axis transoesophageal views
 more precise measurements of aortic annulus

40. 3D ECHOCARDIOGRAPHY

41.  3D =short-axis views
 en face not only from the left ventricle, but also from the aortic
root or any desired unconventional orientation.
 valve morphology and cusp number, since the commissures are
oriented upwards .

42.  en face visualization of left ventricular outflow tract/aortic
annulus

45. THANK YOU