Anatomy of the aortic root: implications for valve-sparing surgery.

The aortic root connects the heart to the systemic circulation and is a highly sophisticated and complex structure. Each component of the aortic root - although simple in its macroscopic morphology - has an optimal macroscopic and microscopic structure and anatomical architecture (1) which contributes to the function of the aortic root as a whole: the intermittent, unidirectional channeling of large volumes of fluid, while maintaining laminar flow, minimal resistance and least possible tissue stress and damage, during varying haemodynamic conditions and demands (2-4). This well-coordinated dynamic behavior of all aortic root components has been shown to be of importance for specific flow characteristics, coronary perfusion and left ventricular function (5-8). On the rare occasions when any aortic root component fails, it is the recognition of the complexity, scope and superiority of this structure—far better than any man-made replacement—that has led to the development of reparative, or ‘sparing’, surgical techniques that respect the functional and anatomical existence of the individual parts of the aortic root (9-12). For the communication and discussion of these techniques among surgeons a deep understanding of the anatomy of the aortic root and a generally accepted nomenclature is of fundamental importance (13-15).