Surgical Anatomy of the Aortic Annulus: Landmarks for External Annuloplasty in Aortic Valve Repair

Khelil, Nizar; Sleilaty, Ghassan; Palladino, Mariangela; Fouda, Mahmoud; Escande, Remi; Debauchez, Mathieu; Centa, Isabelle Di; Lansac, Emmanuel

doi:10.1016/j.athoracsur.2014.12.034

Cited by 64 publications

(44 citation statements)

References 27 publications

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“…The ring was implanted above the AB on average 2 mm in the right coronary nadir, 0 mm in the left coronary, and 2 mm below the AB in the noncoronary nadir, remaining stable in the follow-up. These measurements correlate very closely with the data of two anatomic studies published by Khelil and colleagues [17] and de Kerchove and colleagues [18]. Beside these findings, the study showed the annuloplasty to be effective and stable in follow-up, confirmed as well by clinical data.…”

Section: Commentsupporting

confidence: 87%

“…The limit of proximal dissection of the aortic root corresponds to the external aspect of the VAJ, and recently a refinement of the VAJ definition has been done, describing that this is not a planar circle strictly above the AB as initially thought. The VAJ is a three-dimensional curvilinear circle partially at the level of the AB and partially above (Fig 1) [17,18]. In this study, where aortic root remodeling with the implantation of an external aortic annuloplasty ring has been performed, the VAJ serves as a "landing zone" for the annuloplasty ring; therefore, we aimed to call it annuloplasty ring base (ARB).…”

Section: Definition Of Aortic Annulusmentioning

confidence: 99%

“…The goal of circumferential annuloplasty is to target the AB, and for that the aortic root should be dissected until reaching the AB. This has been reported to be not fully feasible, whereas the limit of proximal dissection of the aortic root corresponds to the external aspect of the VAJ [15][16][17][18]. The VAJ, in fact, serves as a "landing zone" for the external annuloplasty ring.…”

Section: Commentmentioning

confidence: 99%

See 2 more Smart Citations

An Expansible Aortic Ring in Aortic Root Remodeling: Exact Position, Pulsatility, Effectiveness, and Stability in Three-Dimensional CT Study

Holubec

Higashigaito

Bëlobrádek

et al. 2017

The Annals of Thoracic Surgery

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Section: Commentsupporting

confidence: 87%

Section: Definition Of Aortic Annulusmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

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An Expansible Aortic Ring in Aortic Root Remodeling: Exact Position, Pulsatility, Effectiveness, and Stability in Three-Dimensional CT Study

Holubec

Higashigaito

Bëlobrádek

et al. 2017

The Annals of Thoracic Surgery

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“…External dissection down to the subvalvular plane is very important in external ring annuloplasty or reimplantation root procedures. On tricuspid AVs with normal sized aortic roots, external dissection of the annulus may be achieved down to the subvalvular level below the nadir of the left and the non-coronary cusps (basal ring) and in 80% of cases below or within 3 mm of the nadir of the right cusp (7,(17)(18)(19)(20)(21). Of importance to the surgical technique of dissecting down to the subvalvular level, it is difficult to fully reach down to the subvalvular plane in the region below the right-non commissure.…”

Section: Anatomical Landmarks For Aortic Annuloplastymentioning

confidence: 99%

“…Here, the membranous septum limits the dissection plane and the base of the right-non interleaflet triangle corresponds externally to the insertion of the membranous septum, right atrium wall, infundibulum and septal leaflet of the tricuspid valve (18). Therefore, by dissecting down to this deepest plane, the external annuloplasty ring or the proximal suture line of the reimplantation tube graft would fully match the subvalvular plane below at least the left and non-coronary cusps and remain below or within 3 mm of the nadir of the right coronary cusp 80% of the time ( Figure 2).…”

Section: Anatomical Landmarks For Aortic Annuloplastymentioning

confidence: 99%

Rationale for aortic annuloplasty to standardise aortic valve repair

Youssefi¹,

El-Hamamsy²,

Lansac³

2019

Ann. Cardiothorac. Surg.

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Available evidence shows that aortic valve repair reduces valve-related mortality and improves quality of life compared to prosthetic aortic valve replacement. One of the most important predictors of bicuspid and tricuspid aortic valve repair failure is the absence of treating a dilated aortic annulus greater than 25-28 mm. Competency of the aortic valve depends on multiple factors including the diameter of the annulus, sinotubular junction, valve cusps and commissures. Dystrophic aortic insufficiency (AI) is the commonest cause of AI in the Western world and is characterised by dilatation of the aortic annulus (≥25 mm), sinuses and/or sinotubular junction (≥30 mm). Depending on whether the sinuses of Valsalva and/or tubular ascending aorta are dilated, three phenotypes can be identified: dilated aortic root, dilated ascending aorta and isolated AI. All three phenotypes are associated with a dilated aortic annulus. Aortic annuloplasty reduces the dilated aortic annulus and improves the surface of coaptation, as in the case of mitral valve repair. In treating AI, it is also important to restore the physiological sinotubular junction/annulus ratio, which can be carried out with remodeling root repair + subvalvular annuloplasty (for dilated aortic root), tubular ascending aorta replacement + subvalvular annuloplasty (for dilated ascending aorta) and double sub-and supra-valvular annuloplasty (for isolated AI). Aortic annuloplasty is now considered an essential component of aortic valve repair and valve-sparing root surgery.

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The aortic root hexagon as an aide memoire to the important surgical landmarks

et al. 2020

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Background: The anatomy of the aortic root and its relationship to cardiac landmarks is important for valve-sparing surgery and understanding the pathology of lesions arising in this structure. Rapid understanding of the key anatomical details can be achieved by a geometrical concept based on the shape of a hexagon. Methods: Definitions, structure, and key anatomical concepts of the aortic root according to the current literature were reviewed. Thirty pig hearts were dissected to explore the relationships of the six points on the aortic root. Six double 2/0 ethibond needles were placed into the six points at 90. The passage of the needles through the specific cardiac landmarks at each point was noted. The aortic root hexagon is a geometrical structure formed by two triangles superimposed on each other. The six points in the hexagon relate to important adjacent cardiac landmarks. Results: The two best-known anatomical relationships are of the left-non coronary aortic commissure to the longitudinal axis of symmetry of the aortic leaflet of the mitral valve and the relationship of the nadir of the noncoronary aortic valve leaflet to the medial commissure of the mitral valve. The other four points are related to equally significant and well defined anatomical landmarks. Conclusion: The aortic root hexagon is made by two triangles superimposed on each other, these are the commissural and nadir triangles respectively. We have found this concept to be a quick way to learn and remember the key anatomical relationships of the aortic root.

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Surgical Anatomy of the Aortic Annulus: Landmarks for External Annuloplasty in Aortic Valve Repair

Cited by 64 publications

References 27 publications

An Expansible Aortic Ring in Aortic Root Remodeling: Exact Position, Pulsatility, Effectiveness, and Stability in Three-Dimensional CT Study

An Expansible Aortic Ring in Aortic Root Remodeling: Exact Position, Pulsatility, Effectiveness, and Stability in Three-Dimensional CT Study

Rationale for aortic annuloplasty to standardise aortic valve repair

The aortic root hexagon as an aide memoire to the important surgical landmarks

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