Skip to main content
SpringerLink
Log in

Geometry of cusp and root determines aortic valve function

  • Review Article
  • Published:
Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

The aortic valve is the functional unit of cusp and root. Various geometrical and functional analyses for the aortic valve unit have been executed to understand normal valve configuration and improve aortic valve repair. Different concepts and procedures have then been proposed for reparative approach, and aortic valve repair is still not standardized like mitral valve repair. It has become apparent, however, that interpretation of the geometry of the aortic cusp and root and its appropriate application to operative strategy lead to creating a functioning aortic valve. Herein, the aortic valve geometry and its clinical implications are reviewed to provide information for the selection of appropriate operative strategies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Taylor WJ, Thrower WB, Black H, Harken DE. The surgical correction of aortic insufficiency by circumclusion. J Thorac Surg. 1958;35:192–205.

    CAS  PubMed  Google Scholar 

  2. Carpentier A. Cardiac valve surgery--the "French correction". J Thorac Cardiovasc Surg. 1983;86:323–37.

    CAS  PubMed  Google Scholar 

  3. Duran CG. Reconstructive techniques for rheumatic aortic valve disease. J Card Surg. 1988;3:23–8.

    CAS  PubMed  Google Scholar 

  4. Cosgrove DM, Rosenkranz ER, Hendren WG, Bartlett JC, Stewart WJ. Valvuloplasty for aortic insufficiency. J Thorac Cardiovasc Surg. 1991;102:571–6.

    CAS  PubMed  Google Scholar 

  5. Frater RW. Aortic valve insufficiency due to aortic dilatation: correction by sinus rim adjustment. Circulation. 1986;74:I136–42.

    CAS  PubMed  Google Scholar 

  6. Sarsam MA, Yacoub M. Remodeling of the aortic valve anulus. J Thorac Cardiovasc Surg. 1993;105:435–8.

    CAS  PubMed  Google Scholar 

  7. 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.

    CAS  PubMed  Google Scholar 

  8. Schäfers HJ, Schmied W, Marom G, Aicher D. Cusp height in aortic valves. J Thorac Cardiovasc Surg. 2013;146:269–74.

    PubMed  Google Scholar 

  9. Schäfers HJ, Aicher D, Riodionycheva S, et al. Bicuspidization of the unicuspid aortic valve: a new reconstructive approach. Ann Thorac Surg. 2008;85:2012–8.

    PubMed  Google Scholar 

  10. Anderson RH. Clinical anatomy of the aortic root. Heart. 2000;84:670–3.

    CAS  PubMed  PubMed Central  Google Scholar 

  11. de Kerchove L, Jashari R, Boodhwani M, et al. Surgical anatomy of the aortic root: implication for valve-sparing reimplantation and aortic valve annuloplasty. J Thorac Cardiovasc Surg. 2015;149:425–33.

    PubMed  Google Scholar 

  12. Khelil N, Sleilaty G, Palladino M, et al. Surgical anatomy of the aortic annulus: landmarks for external annuloplasty in aortic valve repair. Ann Thorac Surg. 2015;99:1220–6.

    PubMed  Google Scholar 

  13. Evangelista A, Flachskampf FA, Erbel R, et al. Echocardiography in aortic diseases: EAE recommendations for clinical practice. Eur J Echocardiogr. 2010;11:645–58.

    PubMed  Google Scholar 

  14. Duran CM, Gometza B, Shahid M, Al-Halees Z. Treated bovine and autologous pericardium for aortic valve reconstruction. Ann Thorac Surg. 1998;66:S166–9.

    CAS  PubMed  Google Scholar 

  15. Casselman FP, Gillinov AM, Akhrass R, Kasirajan V, Blackstone EH, Cosgrove DM. Intermediate-term durability of bicuspid aortic valve repair for prolapsing leaflet. Eur J Cardiothorac Surg. 1999;15:302–8.

    CAS  PubMed  Google Scholar 

  16. Pethig K, Milz A, Hagl C, Harringer W, Haverich A. Aortic valve reimplantation in ascending aortic aneurysm: risk factors for early valve failure. Ann Thorac Surg. 2002;73:29–33.

    PubMed  Google Scholar 

  17. Swanson M, Clark RE. Dimensions and geometric relationships of the human aortic valve as a function of pressure. Circ Res. 1974;35:871–82.

    CAS  PubMed  Google Scholar 

  18. Kunzelman KS, Grande KJ, David TE, Cochran RP, Verrier ED. Aortic root and valve relationships. Impact on surgical repair. J Thorac Cardiovasc Surg. 1994;107:162–70.

    CAS  PubMed  Google Scholar 

  19. Schäfers HJ, Aicher D, Langer F, Lausberg HF. Preservation of the bicuspid aortic valve. Ann Thorac Surg. 2007;83:S740–5.

    PubMed  Google Scholar 

  20. Schäfers HJ, Bierbach B, Aicher D. A new approach to the assessment of aortic cusp geometry. J Thorac Cardiovasc Surg. 2006;132:436–8.

    PubMed  Google Scholar 

  21. Bierbach BO, Aicher D, Issa OA, et al. Aortic root and cusp configuration determine aortic valve function. Eur J Cardiothorac Surg. 2010;38:400–6.

    PubMed  Google Scholar 

  22. De Kerchove L, Momeni M, Aphram G, et al. Free margin length and coaptation surface area in normal tricuspid aortic valve: an anatomical study. Eur J Cardiothorac Surg. 2018;53:1040–8.

    PubMed  Google Scholar 

  23. Vanoverschelde JL, van Dyck M, Gerber B, et al. The role of echocardiography in aortic valve repair. Ann Cardiothorac Surg. 2013;2:65–72.

    PubMed  PubMed Central  Google Scholar 

  24. Marom G, Haj-Ali R, Rosenfeld M, Schäfers HJ, Raanani E. Aortic root numeric model: correlation between intraoperative effective height and diastolic coaptation. J Thorac Cardiovasc Surg. 2013;145:303–4.

    PubMed  Google Scholar 

  25. Marom G, Haj-Ali R, Rosenfeld M, Schäfers HJ, Raanani E. Aortic root numeric model: annulus diameter prediction of effective height and coaptation in post-aortic valve repair. J Thorac Cardiovasc Surg. 2013;145:406–11.

    PubMed  Google Scholar 

  26. Marom G, Halevi R, Haj-Ali R, Rosenfeld M, Schäfers HJ, Raanani E. Numerical model of the aortic root and valve: optimization of graft size and sinotubular junction to annulus ratio. J Thorac Cardiovasc Surg. 2013;146:1227–31.

    PubMed  Google Scholar 

  27. le Polain de Waroux JB, Pouleur AC, Goffinet C, et al. Functional anatomy of aortic regurgitation: accuracy, prediction of surgical repairability, and outcome implications of transesophageal echocardiography. Circulation. 2007;116:I264–9.

    PubMed  Google Scholar 

  28. Thubrikar MJ, Labrosse MR, Zehr KJ, Robicsek F, Gong GG, Fowler BL. Aortic root dilatation may alter the dimensions of the valve leaflets. Eur J Cardiothorac Surg. 2005;28:850–5.

    PubMed  Google Scholar 

  29. Vollebergh FE, Becker AE. Minor congenital variations of cusp size in tricuspid aortic valves. Possible link with isolated aortic stenosis. Br Heart J. 1977;39:1006–11.

    CAS  PubMed  PubMed Central  Google Scholar 

  30. Silver MA, Roberts WC. Detailed anatomy of the normally functioning aortic valve in hearts of normal and increased weight. Am J Cardiol. 1985;55:454–61.

    CAS  PubMed  Google Scholar 

  31. David TE, David CM, Feindel CM, Manlhiot C. Reimplantation of the aortic valve at 20 years. J Thorac Cardiovasc Surg. 2017;153:232–8.

    PubMed  Google Scholar 

  32. deKerchove L, Mastrobuoni S, Boodhwani M, et al. The role of annular dimension and annuloplasty in tricuspid aortic valve repair. Eur J Cardiothorac Surg. 2016;49:428–37.

    Google Scholar 

  33. Lansac E, Di Centa I, Sleilaty G, et al. Remodeling root repair with an external aortic ring annuloplasty. J Thorac Cardiovasc Surg. 2017;153:1033–42.

    PubMed  Google Scholar 

  34. Boraita A, Heras ME, Morales F, et al. Reference Values of Aortic Root in Male and Female White Elite Athletes According to Sport. Circ Cardiovasc Imaging. 2016;9:e005292.

    PubMed  Google Scholar 

  35. Kunihara T, Aicher D, Rodionycheva S, et al. Preoperative aortic root geometry and postoperative cusp configuration primarily determine long-term outcome after valve-preserving aortic root repair. J Thorac Cardiovasc Surg. 2012;143:1389–95.

    PubMed  Google Scholar 

  36. Kunihara T, Arimura S, Sata F, Giebels C, Schneider U, Schäfers HJ. Aortic annulus does not dilate over time after aortic root remodeling with or without annuloplasty. J Thorac Cardiovasc Surg. 2018;155:885–94.

    PubMed  Google Scholar 

  37. Aicher D, Kunihara T, Abou Issa O, Brittner B, Gräber S, Schäfers HJ. Valve configuration determines long-term results after repair of the bicuspid aortic valve. Circulation. 2011;123:178–85.

    PubMed  Google Scholar 

  38. Schneider U, Hofmann C, Aicher D, Takahashi H, Miura Y, Schäfers HJ. Suture Annuloplasty Significantly Improves the Durability of Bicuspid Aortic Valve Repair. Ann Thorac Surg. 2017;103:504–10.

    PubMed  Google Scholar 

  39. Nawaytou O, Mastrobuoni S, de Kerchove L, Baert J, Boodhwani M, El Khoury G. Deep circumferential annuloplasty as an adjunct to repair regurgitant bicuspid aortic valves with a dilated annulus. J Thorac Cardiovasc Surg. 2018;156:590–7.

    PubMed  Google Scholar 

  40. Aicher D, Schneider U, Schmied W, Kunihara T, Tochii M, Schäfers HJ. Early results with annular support in reconstruction of the bicuspid aortic valve. J Thorac Cardiovasc Surg. 2013;145:S30–4.

    PubMed  Google Scholar 

  41. David TE, Feindel CM, Armstrong S, Maganti M. Replacement of the ascending aorta with reduction of the diameter of the sinotubular junction to treat aortic insufficiency in patients with ascending aortic aneurysm. J ThoracCardiovascSurg. 2007;133:414–8.

    Google Scholar 

  42. Asano M, Kunihara T, Aicher D, El Beyrouti H, Rodionycheva S, Schäfers HJ. Mid-term results after sinutubular junction remodelling with aortic cusp repair. Eur J Cardiothorac Surg. 2012;42:1010–5.

    PubMed  Google Scholar 

  43. Komiya T, Shimamoto T, Nonaka M, Matsuo T. Is small cusp size is a limitation for aortic valve repair? Eur J CardiothoracSurg. In press.

Download references

Author information

Authors and Affiliations

  1. Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg, Saarland, Germany

    Shunsuke Matsushima, Irem Karliova, Simon Gauer, Shunsuke Miyahara & Hans-Joachim Schäfers

Authors
  1. Shunsuke Matsushima
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Irem Karliova
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Simon Gauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shunsuke Miyahara
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hans-Joachim Schäfers
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hans-Joachim Schäfers.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Not required.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Matsushima, S., Karliova, I., Gauer, S. et al. Geometry of cusp and root determines aortic valve function. Indian J Thorac Cardiovasc Surg 36 (Suppl 1), 64–70 (2020). https://doi.org/10.1007/s12055-019-00813-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12055-019-00813-2

Keywords

Search

Navigation