De Paulis Ruggero, Salica Andrea
Department of Cardiac Surgery, European Hospital, Rome, Italy.
Ann Cardiothorac Surg. 2019 May;8(3):313-321. doi: 10.21037/acs.2019.04.16.
The aortic root is an important anatomical structure positioned at the center of the heart, making it critical to the functioning of the major cardiac chambers. Deep knowledge of the anatomical "surroundings" of the aortic root is crucial for surgeon attempting to spare or repair a leaking aortic valve. In fact, root dissection is a necessary step to "skeletonize" the aortic valve, allowing the surgeon to work on the critical components of its structure, namely the aorto-ventricular junction, the virtual basal ring (VBR) and the sino-tubular junction (STJ). These three components, along with the insertion of the leaflet to the aortic wall, form the skeleton of the aortic valve that is essential in guaranteeing valve competence. A good anatomical proportion between the various component of the skeleton of the aortic valve need to be verified, or re-established in order to set the basis for an optimal aortic valve repair. Once the skeleton of the heart has been correctly addressed, the condition of the valve leaflets need to be considered. Excess of leaflet tissue is treated by leaflet plication or resection and lack of leaflet tissue is addressed by tissue extension with autologous or heterologous materials. In the present manuscript, we highlight the principal structure of the aortic root and describe in detail each anatomical component. This basic anatomical knowledge is also important for a through understanding of the normal function of the valve and root structure during the cardiac cycle. The close boundaries existing between the left ventricular cavity and the aorta are important in explaining the sophisticated function of opening and closing of the aortic valve. Similarly, the role played by the sinuses of Valsalva in regulating the blood flow exiting the ventricle underline the concept that "form follows function" and emphasizes the importance of a good anatomical reconstruction for an optimal and long-lasting valve function.
主动脉根部是位于心脏中心的重要解剖结构，对主要心腔的功能至关重要。深入了解主动脉根部的解剖“周围结构”对于试图保留或修复漏血主动脉瓣的外科医生来说至关重要。事实上，根部解剖是“骨骼化”主动脉瓣的必要步骤，使外科医生能够处理其结构的关键组成部分，即主动脉-心室连接、虚拟基环（VBR）和窦管交界（STJ）。这三个组成部分，连同瓣叶插入主动脉壁，形成了主动脉瓣的骨架，这对于保证瓣膜功能至关重要。需要验证或重新建立主动脉瓣骨架各组成部分之间良好的解剖比例，以便为最佳的主动脉瓣修复奠定基础。一旦心脏的骨架得到正确处理，就需要考虑瓣叶的状况。瓣叶组织过多通过瓣叶折叠或切除处理，瓣叶组织不足则通过自体或异体材料进行组织扩展处理。在本手稿中，我们强调了主动脉根部的主要结构，并详细描述了每个解剖组成部分。这种基本的解剖学知识对于透彻理解心动周期中瓣膜和根部结构的正常功能也很重要。左心室腔和主动脉之间紧密的边界对于解释主动脉瓣复杂的开闭功能很重要。同样，主动脉窦在调节心室流出血流中所起的作用强调了“形态遵循功能”的概念，并强调了良好的解剖重建对于实现最佳和持久瓣膜功能的重要性。
