Belitsis Georgios, Finch Jonathan Robert
Department of Children's Cardiovascular Disease, Institute of Cardiovascular Science, University College London, London, UK.
Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, London, UK.
Indian J Thorac Cardiovasc Surg. 2024 Sep;40(5):582-589. doi: 10.1007/s12055-024-01755-0. Epub 2024 Jun 1.
The aortic root is the segment of the aorta between the left ventricular outflow tract and the sinotubular junction of the ascending aorta, and, on one level, is merely a tube, with a valve at its base, dynamic structures below it, and notable for having the life-limiting coronary arteries originate within its sinuses. However, we propose that the perception of the aortic root has been historically grossly over-simplified by virtue of a bias towards its internal aspect, in terms of coronary ostia and subvalvar relationships through the fibrous skeleton and in so-doing a myocardial component on the external aspect has all but been ignored. This myocardial mass, a component of the left ventricular free wall, is sometimes termed the 'left ostial process' but appears to be rarely, if ever, considered by anatomists, cardiologists, and surgeons alike. By virtue of its direct continuity to the aortic root and proximal left coronary artery, it may have unique roles and, at the very least, deserves greater recognition and investigation. Herein, we propose that it could play a crucial role in cardiac embryology including coronary dominance, and may afford a physiological advantage, to the extent that it may have been selected for in evolutionary terms.
主动脉根部是主动脉在左心室流出道与升主动脉窦管交界处之间的部分，从某种程度上来说，它仅仅是一根管子，其基部有一个瓣膜，下方有动态结构，并且其显著特点是有决定生命的冠状动脉起源于其窦内。然而，我们认为，由于历史上对主动脉根部内部的偏向，从冠状动脉口和通过纤维骨架的瓣下关系方面来看，主动脉根部的概念在很大程度上被过度简化了，这样一来，其外部的心肌成分几乎被忽视了。这种心肌块是左心室游离壁的一个组成部分，有时被称为“左口突”，但解剖学家、心脏病学家和外科医生似乎都很少考虑到它，即便考虑过也极为罕见。由于它与主动脉根部和左冠状动脉近端直接相连，它可能具有独特的作用，至少值得更多的认识和研究。在此，我们提出它可能在心脏胚胎学中发挥关键作用，包括冠状动脉优势，并且可能具有生理优势，从进化角度来看，它甚至可能是被选择保留下来的。
