title: Surgical anatomy of the aortic root: implication for valve-sparing reimplantation and aortic valve annuloplasty.
abstract: To enhance the reproducibility of aortic valve-sparing reimplantation and annuloplasty, we analyzed the topographic relationship between the ventriculoaortic junction (VAJ), basal ring (BR), and sinotubular junction (STJ). The root base thickness is also quantified.
  
  
  
  Fifty-eight fresh human aortic valves were analyzed. The root was dissected to the limit where the aortic wall terminates into the cardiac structures (VAJ). Root height was measured externally from the STJ to the VAJ and internally from the STJ to the BR defined as the plane passing through the cusps nadir. The root base thickness was measured at the BR and orthogonal to the internal wall; except at the right coronary sinus, where it was measured between the BR internally and the VAJ externally. Measurements were taken at the middle of the 3 sinuses and commissures.
  
  
  
  The VAJ is at the same level as the BR from the noncoronary sinus (-0.1 ± 0.9 mm) to the left coronary sinus (0.5 ± 1.3 mm); it is above the BR from the left/right commissure (4.6 ± 1.4 mm) to the right/non commissure (2.5 ± 1.6 mm). The external root height was highest at the non/left commissure (21.5 ± 2.6 mm) followed by the right/non commissure (19.2 ± 2.3 mm) then the left/right commissure (15.7 ± 2.2 mm) (P < .05). The mean root base thickness was 3.2 mm, ranging from 1 ± 0 mm at the left/non commissure to 6.2 ± 1.2 mm at the right coronary sinus (P < .001).
  
  
  
  The VAJ is not planar; it is above the level of the BR from the left/right to the right/non commissure. As a consequence, the external height of the non/left commissure is greater than the other 2 commissures. These findings should be taken into consideration when performing aortic valve-sparing reimplantation or external annuloplasty.
authors.affiliation: Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium; Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium. Electronic address: laurent.dekerchove@uclouvain.be.
authors.forename: Laurent
authors.initials: L
authors.lastname: de Kerchove
authors.affiliation: Europen Homograft Bank, Military Hospital, Brussels, Belgium.
authors.forename: Ramadan
authors.initials: R
authors.lastname: Jashari
authors.affiliation: Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Munir
authors.initials: M
authors.lastname: Boodhwani
authors.affiliation: Institute of Mechanics, Materials and Civil Engineering, Université Catholique de Louvain, Louvain-la-Neuve, Belgium.
authors.forename: Khanh Tran
authors.initials: KT
authors.lastname: Duy
authors.affiliation: Pôle Morphologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain Brussels, Belgium.
authors.forename: Benoit
authors.initials: B
authors.lastname: Lengelé
authors.affiliation: Pôle de Chirurgie Expérimentale et Transplantation, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain Brussels, Belgium.
authors.forename: Pierre
authors.initials: P
authors.lastname: Gianello
authors.affiliation: Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Mosala Nezhad
authors.affiliation: Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.
authors.forename: Parla
authors.initials: P
authors.lastname: Astarci
authors.affiliation: Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.
authors.forename: Philippe
authors.initials: P
authors.lastname: Noirhomme
authors.affiliation: Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.
authors.forename: Gebrine
authors.initials: G
authors.lastname: El Khoury
mesh_terms: D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic / Q000033:anatomy & histology* / Q000601:surgery*; D001021:Aortic Valve / Q000033:anatomy & histology* / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000601:surgery*; D002102:Cadaver; D058385:Cardiac Valve Annuloplasty / Q000379:methods*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D014019:Tissue Donors
keywords: annuloplasty; aortic insufficiency; aortic valve anatomy; aortic valve repair; valve-sparing surgery