Department of Pediatric Cardiology, Cleveland Clinic Children's and The Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
Heart Institute, Johns Hopkins All Children's Hospital, St Petersburg, Florida.
Cardiol Young. 2023 Jul;33(7):1060-1068. doi: 10.1017/S1047951123001233. Epub 2023 Jun 8.
Over the past 2 decades, several categorizations have been proposed for the abnormalities of the aortic root. These schemes have mostly been devoid of input from specialists of congenital cardiac disease. The aim of this review is to provide a classification, from the perspective of these specialists, based on an understanding of normal and abnormal morphogenesis and anatomy, with emphasis placed on the features of clinical and surgical relevance. We contend that the description of the congenitally malformed aortic root is simplified when approached in a fashion that recognizes the normal root to be made up of 3 leaflets, supported by their own sinuses, with the sinuses themselves separated by the interleaflet triangles. The malformed root, usually found in the setting of 3 sinuses, can also be found with 2 sinuses, and very rarely with 4 sinuses. This permits description of trisinuate, bisinuate, and quadrisinuate variants, respectively. This feature then provides the basis for classification of the anatomical and functional number of leaflets present. By offering standardized terms and definitions, we submit that our classification will be suitable for those working in all cardiac specialties, whether pediatric or adult. It is of equal value in the settings of acquired or congenital cardiac disease. Our recommendations will serve to amend and/or add to the existing International Paediatric and Congenital Cardiac Code, along with the Eleventh iteration of the International Classification of Diseases provided by the World Health Organization.
在过去的 20 年中，已经提出了几种用于主动脉根部异常的分类方法。这些方案主要缺乏先天性心脏病专家的参与。本综述的目的是从这些专家的角度提供一种分类方法，基于对正常和异常形态发生和解剖结构的理解，重点是具有临床和手术相关性的特征。我们认为，当以认识到正常根部由 3 个瓣叶组成，由各自的窦支持，窦本身由瓣间三角分隔的方式来描述先天性畸形的主动脉根部时，描述会变得更加简单。通常在 3 个窦的情况下发现畸形根部，也可以在 2 个窦或非常罕见的 4 个窦的情况下发现畸形根部。这分别允许描述三尖瓣、二瓣化和四瓣化变体。这个特征然后为目前存在的瓣叶的解剖学和功能数量的分类提供了基础。通过提供标准化的术语和定义，我们认为我们的分类将适合所有心脏专业的人员，无论是儿科还是成人。在获得性或先天性心脏病的情况下，它同样具有价值。我们的建议将用于修订和/或补充现有的国际儿科和先天性心脏病代码，以及世界卫生组织提供的第十一次国际疾病分类。
