Functional Anatomy and Dynamics of the Aortic Root

Chapter

Abstract

The anatomy of the aortic root is a sophisticated structure uniquely designed to optimize its function. Each component of the aortic root (Fig. 3.1) is deliberately assembled to allow the stroke volume to be ejected as a laminar flow with minimal resistance and minimal tissue wear and tear [1]. This organized action of the components of the aortic root is critical to the efficiency of the left ventricular pump, normal coronary blood flow, and the distinctive flow pattern in the aorta [2–6]. Thus, an understanding of the functional anatomy of the aortic root is essential to understand the clinical consequences of the disruption of this complex structure. This understanding also is key to the surgical repair techniques aimed to restore this sophisticated anatomy in various diseases of the aortic root. The following section will first describe the structure of the aortic root and in the second part describe the coordinated functioning of this complex yet intuitively efficient structure.

References

  1. 1.
    Thubrikar MJ. The aortic valve. 1st ed. Boca Raton, FL: CRC; 1981.Google Scholar
  2. 2.
    Bellhouse BJ, Bellhouse FH. Mechanism of closure of the aortic valve. Nature. 1968;217:86–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Bellhouse BJ, Bellhouse FH, Reid KG. Fluid mechanics of the aortic root with application to coronary flow. Nature. 1968;219:1059–61.CrossRefPubMedGoogle Scholar
  4. 4.
    Thubrikar M, Piepgrass WC, Bosher LP, et al. The elastic modulus of canine aortic valve leaflets in vivo and in vitro. Circ Res. 1980;47:792–800.CrossRefPubMedGoogle Scholar
  5. 5.
    Brewer RJ, Deck JD, Capati B, et al. The dynamic aortic root. Its role in aortic valve function. J Thorac Cardiovasc Surg. 1976;72:413–7.PubMedGoogle Scholar
  6. 6.
    Charitos EI, Sievers HH. Anatomy of the aortic root: implications for valve-sparing surgery. Ann Cardiothorac Surg. 2013;2:53–6.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Anderson RH. Clinical anatomy of the aortic root. Heart. 2000;84:670–3.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Anderson RH. The surgical anatomy of the aortic root. Multimed Man Cardiothorac Surg.  https://doi.org/10.1510/mmcts.2006.002527.
  9. 9.
    de Kerchove L, Jashari R, Boodhwani M, Duy KT, Lengel B, Gianello P, Nezhad ZM, Astarci P, Noirhomme P, El Khoury G. Surgical anatomy of the aortic root: implication for valve-sparing reimplantation and aortic valve annuloplasty. J Thorac Cardiovasc Surg. 2015;149:425–33.CrossRefPubMedGoogle Scholar
  10. 10.
    Robicsek F, Thubrikar MJ, Cook JW, Fowler B. The congenitally bicuspid aortic valve: how does it function? Why does it fail? Ann Thorac Surg. 2004;77:177–85.CrossRefPubMedGoogle Scholar
  11. 11.
    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.PubMedGoogle Scholar
  12. 12.
    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;103:617–22.PubMedGoogle Scholar
  13. 13.
    David TE, Feindel CM, Bos J. Repair of the aortic valve in patients with aortic insufficiency and aortic root aneurysm. J Thorac Cardiovasc Surg. 1995;109:345–52.CrossRefPubMedGoogle Scholar
  14. 14.
    David TE. Surgical treatment of aortic valve disease. Nat Rev Cardiol. 2013;10:375–86.CrossRefPubMedGoogle Scholar
  15. 15.
    Sievers HH, Hemmer W, Beyersdorf F, Moritz A, Moosdorf R, Lichtenberg A, Misfeld M, Charitos EI, on behalf of the Working Group for Aortic Valve Surgery of the German Society of Thoracic and Cardiovascular Surgery. The everyday used nomenclature of the aortic root components: the tower of Babel? Eur J Cardiothorac Surg. 2012;41:478–82.CrossRefPubMedGoogle Scholar
  16. 16.
    Underwood MJ, El Khoury G, Deronck D, Glineur D, Dion R. The aortic root: structure, function, and surgical reconstruction. Heart. 2000;83:376–80.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Lansac E, Lim HS, Shomura Y, Lim KH, Rice NT, Goetz W, Acar C, Duran CMG. A four-dimensional study of the aortic root dynamics. Eur J Cardiothorac Surg. 2002;22:497–503.CrossRefPubMedGoogle Scholar
  18. 18.
    Sutton JP III, 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.CrossRefPubMedGoogle Scholar
  19. 19.
    Furukawa K, Ohteki H, Cao ZL, Doi K, Narita Y, Minato N, Itoh T. Does dilatation of the sinotubular junction cause aortic regurgitation? Ann Thorac Surg. 1999;68:949–54.CrossRefPubMedGoogle Scholar
  20. 20.
    de Kerchove L, El Khoury G. Anatomy and pathophysiology of the ventriculo-aortic junction: implication in aortic valve repair surgery. Ann Cardiothorac Surg. 2013;2:57–64.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Schafers HJ, Schmied W, Marom G, Aicher D. Cusp height in aortic valves. J Thorac Cardiovasc Surg. 2013;146:269–74.CrossRefPubMedGoogle Scholar
  22. 22.
    Calleja A, Thavendiranathan P, Ionasec RI, Houle H, Liu S, Voigt I, Sai Sudhakar C, Crestanello J, Ryan T, Vannan MA. Automated quantitative 3-dimensional modeling of the aortic valve and root by 3-dimensional transesophageal echocardiography in normals, aortic regurgitation, and aortic stenosis: comparison to computed tomography in normals and clinical implications. Circ Cardiovasc Imaging. 2013;6(1):99–108.CrossRefPubMedGoogle Scholar
  23. 23.
    Kim DH, Handschumacher MD, Levine RA, Sun BJ, Jang JY, Yang DH, Kang JW, Song JM, Kang DH, Lim TH, Song JK. Aortic valve adaptation to aortic root dilatation: insights into the mechanism of functional aortic regurgitation from 3-dimensional cardiac computed tomography. Circ Cardiovasc Imaging. 2014;7:828–35.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Regeer MV, Kamperidis V, Versteegh MI, Schalij MJ, Marsan NA, Bax JJ, et al. Three-dimensional transoesophageal echocardiography of the aortic valve and root: changes in aortic root dilation and aortic regurgitation. Eur Heart J Cardiovasc Imaging. 2016.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Xiao Zhou
    • 1
    • 2
  • Mani A. Vannan
    • 1
    • 2
  • Khalil Fattouch
    • 1
    • 2
  1. 1.Echo DepartmentPLA Chinese HospitalBeijingChina
  2. 2.Marcus Heart Valve CenterPiedmont Heart InstituteAtlantaUSA

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