The Aortic Root

Revisiting Cardiac Anatomy: A Computed-Tomography-Based Atlas and Reference

Volumn , Issue , 2010, Pages 133-161

  Gambarin, Fabiana Isabella ^a   Massetti, Massimo ^b   Dore, Roberto ^a   Saloux, Eric ^b   Favalli, Valentina ^a   Arbustini, Eloisa ^a  

^a FONDAZIONE IRCCS POLICLINICO SAN MATTEO   (Italy)

^b CAEN UNIVERSITY HOSPITAL   (France)

Author keywords

Aortic root; Aortic root cut between noncoronary sinus (nc) and left coronary sinus; Aortic root, complex functional unit situated between left ventricular outflow tract (LVOT) and ascending aorta; Aortic valve structure (semilunar leaflets and commissures); Echocardiography, pivotal imaging tool for diagnosis and monitoring of pathology of aortic root; Interleaflets triangles; Pathophysiology of aortic root dysfunction; Sinotubular junction or ridge forming a circular ring at level of attachments of aortic commissures; Valsalva sinuses; Ventriculoaortic junction (or aortic annulus) composed of cusp bases and interleaflets triangles

Indexed keywords

EID: 84870389459     PISSN: None     EISSN: None     Source Type: Book    
DOI: 10.1002/9781444323191.ch8     Document Type: Chapter

References (51)

1. Underwood MJ, El Khoury G, Deronck D, Glineur D, Dion R. (2000) The aortic root: structure, function, and surgical reconstruction. Heart 83: 376-380.
2. Guiney TE, Davies MJ, Parker DJ, Leech GJ, Leatham A. (1987) The aetiology and course of isolated severe aortic regurgitation: a clinical, pathological, and echocardiographic study. Heart 58: 358-368.
3. Anderson RH. (2006) The surgical anatomy of the aortic root. Multimedia Manual of Cardiothoracic Surgery (MMCTS). doi: 10.1510/mmcts.2006.002527.
4. Feindel CM, David TE. (2004) Aortic valve sparing operations: basic concepts. Int J Cardiol 97(Suppl 1): 61-66.
5. Sutton JP , Ho SY, Anderson RH. (1995) The forgotten interleaflet triangles: a review of the surgical anatomy of the aortic valve. Ann Thorac Surg 59: 419-427.
6. Sacks MS, Smith DB, Hiester ED. (1998) The aortic valve microstructure: effects of transvalvular pressure. J Biomed Mater Res 41: 131-141.
7. Vesely I. (1998) The role of elastin in aortic valve mechanics. J Biomech 31: 115-123.
8. Maselli D, Montalto A, Santise G, Minardi G, Manzara C, Musumeci F. (2005) A normogram to anticipate dimension of neo-sinuses of Valsalva in valve-sparing aortic operations. Eur J Cardiothorac Surg 27: 831-835.
9. Hopkins RA. (2003) Aortic valve leaflet sparing and salvage surgery: evolution of techniques for aortic root reconstruction. Eur J Cardiothorac Surg 24: 886-897.
10. Robicsek F. (1991) Leonardo da Vinci and the sinuses of Valsalva. Ann Thorac Surg 52: 328-335.
11. Kunzelman KS, Grande KJ, David TE, Cochran RP, Verrier ED. (1994) Aortic root and valve relationships. Impact on surgical repair. J Thorac Cardiovasc Surg 107: 162-170.
12. Jeanmart H, de Kerchove L, Glineur D et al. (2007) Aortic valve repair: the functional approach to leaflet prolapse and valve-sparing surgery. Ann Thorac Surg 83: S746-S751.
13. El Khoury G, Glineur D, Rubay J et al. (2005) Functional classification of aortic root/valve abnormalities and their correlation with etiologies and surgical procedures. Curr Opin Cardiol 20: 115-121.
14. Silver MA, Roberts WC. (1985) Detailed anatomy of the normally functioning aortic valve in hearts of normal and increased weight. Am J Cardiol 55: 454-461.
15. Perrin A, Aerichide N, Gravier J, Cahen P, Froment R. (1962) Interventricular communications with aortic insufficiency (Laubry-Pezzi syndrome). Arch Mal Coeur Vaiss 55: 289-310.
16. de Waroux JB, Pouleur AC, Goffinet C et al. (2007) Functional anatomy of aortic regurgitation: accuracy, prediction of surgical repairability, and outcome implications of transesophageal echocardiography. Circulation 116(11 Suppl): I264-I269.
17. Ferencik M, Pape LA. (2003) Changes in size of ascending aorta and aortic valve function with time in patients with congenitally bicuspid aortic valves. Am J Cardiol 92: 43-46.
18. Cecconi M, Manfrin M, Moraca A et al. (2005) Aortic dimensions in patients with bicuspid aortic valve without significant valve dysfunction. Am J Cardiol 95: 292-294.
19. Dore A, Brochu MC, Baril JF, Guertin MC, Mercier LA. (2003) Progressive dilation of the diameter of the aortic root in adults with a bicuspid aortic valve. Cardiol Young 13: 526-531.
20. Beroukhim RS, Kruzick TL, Taylor AL, Gao D, Yetman AT. (2006) Progression of aortic dilation in children with a functionally normal bicuspid aortic valve. Am J Cardiol 98: 828-830.
21. Grotenhuis HB, Ottenkamp J, Westenberg JJ et al. (2007) Reduced aortic elasticity and dilatation are associated with aortic regurgitation and left ventricular hypertrophy in nonstenotic bicuspid aortic valve patients. J Am Coll Cardiol 49: 1660-1665.
22. Keane MG, Wiegers SE, Plappert T, Pochettino A, Bavaria JE, Sutton MG (2000). Bicuspid aortic valves are associated with aortic dilatation out of proportion to coexistent valvular lesions. Circulation 102(19 Suppl 3): 11135-11139.
23. Fedak PW, Verma S, David TE, Leask RL,Weisel RD, Butany J. (2002) Clinical and pathophysiological implications of a bicuspid aortic valve. Circulation 106: 900-904.
24. Cecconi M, Nistri S, Quarti A et al. (2006) Aortic dilatation in patients with bicuspid aortic valve. J Cardiovasc Med (Hagerstown) 7: 11-20.
25. Germing A,M̈ugge A. (2009) What the cardiac surgeon needs to know prior to aortic valve surgery: impact of echocardiography. Eur J Cardiothorac Surg. 35(6): 960-964.
26. Sahn DJ, DeMaria A, Kisslo J, Weyman A. (1978) Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation 58: 1072-1083.
27. Roman MJ, Devereux RB, Kramer-Fox R, O'Loughlin J. (1989) Two-dimensional echocardiographic aortic root dimensions in normal children and adults. Am J Cardiol 64: 507-512.
28. Roman MJ, Devereux RB, Niles NW et al. (1987) Aortic root dilatation as a cause of isolated, severe aortic regurgitation. Prevalence, clinical and echocardiographic patterns, and relation to left ventricular hypertrophy and function. Ann Intern Med 106: 800-807.
29. Padial LR, Oliver A, Sagie A, Weyman AE, King ME, Levine RA.(1997) Two-dimensional echocardiographic assessment of the progression of aortic root size in 127 patients with chronic aortic regurgitation: role of the supraaortic ridge and relation to the progression of the lesion. Am Heart J 134: 814-821.
30. Du Bois D, Du Bois EF. (1989) A formula to estimate the approximate surface area if height and weight be known. 1916. Nutrition 5(5): 303-311.
31. Mosteller RD. (1987) Simplified calculation of body-surface area. N Engl J Med 317: 1098.
32. Haycock GB, Schwartz GJ, Wisotsky DH. (1978) Geometric method for measuring body surface area: a height-weight formula validated in infants, children, and adults. J Pediatr 93: 62-66.
33. Gehan EA, George SL. (1970) Estimation of human body surface area from height and weight. Cancer Chemother Rep 54: 225-235.
34. Vasan RS, Larson MG, Levy D. (1995) Determinants of echocardiographic aortic root size. The Framingham Heart Study. Circulation 91: 734-740.
35. Furukawa K, Ohteki H, Cao ZL et al. (1999) Does dilatation of the sinotubular junction cause aortic regurgitation? Ann Thorac Surg 68: 949-953.
36. Zarauza J, Ares M, Vílchez FG et al. (1998) An integrated approach to the quantification of aortic regurgitation by Doppler echocardiography. Am Heart J 136: 1030-1041.
37. Evangelista A, del Castillo HG, Calvo F et al. (2000) Strategy for optimal aortic regurgitation quantification by Doppler echocardiography: agreement among different methods. Am Heart J 139: 773-781.
38. Perry GJ,Helmcke F,Nanda NC, Byard C, Soto B. (1987) Evaluation of aortic insufficiency byDoppler color flow mapping. J Am Coll Cardiol 9: 952-959.
39. Pye M, Rae AP, Hutton I, Cobbe SM. (1990) Quantification of aortic regurgitation using continuous and pulsed wave Doppler echocardiography. Int J Cardiol 27: 101-106.
40. Tribouilloy C, Avinée P, Shen WF, Rey JL, Slama M, Lesbre JP. (1991) End diastolic flow velocity just beneath the aortic isthmus assessed by pulsed Doppler echocardiography: a new predictor of the aortic regurgitant fraction. Br Heart J 65: 37-40.
41. Mitani M, Tamai J, Miyatake K. (1994) Consequence of diseases in aorta on evaluation of aortic regurgitation by aortic flow velocity profiles. Angiology 45: 613-619.
42. La Canna G, Maisano F, De Michele L et al. (2009) Determinants of the degree of functional aortic regurgitation in patients with anatomically normal aortic valve and ascending thoracic aorta aneurysm. Transoesophageal Doppler echocardiography study. Heart 95: 130-136.
43. Neuman YM, Brasch AV, Kobal S et al. (2003) Comparison of transthoracic and intraoperative transesophageal color flow Doppler assessment of mitral and aortic regurgitation. Cardiology 99: 145-152.
44. Leye M, Brochet E, Lepage L et al. (2009) Size-adjusted left ventricular outflow tract diameter reference values: a safeguard for the evaluation of the severity of aortic stenosis. J Am Soc Echocardiogr 22(5): 445-451.
45. Houck RC, Cooke JE, Gill EA. (2006) Live 3D echocardiography: a replacement for traditional 2D echocardiography? AJR Am J Roentgenol 187: 1092-1106.
46. Vogel M, Ho SY, Anderson RH. (1995) Comparison of three dimensional echocardiographic findings with anatomical specimens of various congenitally malformed hearts. Br Heart J 73: 566-570.
47. Khaw AV, von Bardeleben RS, Strasser C et al. (2008) Direct measurement of left ventricular outflow tract by transthoracic real-time 3D-echocardiography increases accuracy in assessment of aortic valve stenosis. Int J Cardiol. In press.
48. Lin FY, Devereux RB, Roman MJ et al. (2008) Assessment of the thoracic aorta by multidetector computed tomography: age- and sex-specific reference values in adults without evident cardiovascular disease. J Cardiovasc Comput Tomogr 2: 298-308.
49. Kazui T, Kin H, Tsuboi J,Yoshioka K,Okabayashi H, Kawazoe K. (2008) Perioperative dynamic morphological changes of the aortic annulus during aortic root remodeling with aortic annuloplasty at systolic and diastolic phases. J Heart ValveDis 17: 366-370.
50. Lausberg H, Scḧafers HJ. (2004) Recent progress in heart valve surgery: innovation or evolution? Minerva Cardioangiol 52: 243-254.
51. Dapunt OE, Easo J, Hölzl PP et al. (2008) Stentless full root bioprosthesis in surgery for complex aortic valve-ascending aortic disease: a single center experience of over 300 patients. Eur J Cardiothorac Surg 33: 554-559.