The anatomy of the aortic root

Loukas, Marios; Bilinsky, Esther; Bilinsky, Samuel; Blaak, Christa; Tubbs, R. Shane; Anderson, Robert H.

doi:10.1002/ca.22295

Cited by 42 publications

(41 citation statements)

References 26 publications

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“…Each SLV has three leaflets, also known as cusps. Unlike the AVV, SLV lack external support, though the AV has a unique supporting structure within the aortic root, known as the fibrous annulus, which holds it in place (150). …”

Section: Heart Valve Functional Physiologymentioning

confidence: 99%

Heart Valve Biomechanics and Underlying Mechanobiology

Ayoub

Ferrari

Gorman

et al. 2016

Comprehensive Physiology

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Heart valves control unidirectional blood flow within the heart during the cardiac cycle. They have a remarkable ability to withstand the demanding mechanical environment of the heart, achieving lifetime durability by processes involving the ongoing remodeling of the extracellular matrix. The focus of this review is on heart valve functional physiology, with insights into the link between disease-induced alterations in valve geometry, tissue stress, and the subsequent cell mechanobiological responses and tissue remodeling. We begin with an overview of the fundamentals of heart valve physiology and the characteristics and functions of valve interstitial cells (VICs). We then provide an overview of current experimental and computational approaches that connect VIC mechanobiological response to organ- and tissue-level deformations and improve our understanding of the underlying functional physiology of heart valves. We conclude with a summary of future trends and offer an outlook for the future of heart valve mechanobiology, specifically, multiscale modeling approaches, and the potential directions and possible challenges of research development.

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Section: Heart Valve Functional Physiologymentioning

confidence: 99%

Heart Valve Biomechanics and Underlying Mechanobiology

Ayoub

Ferrari

Gorman

et al. 2016

Comprehensive Physiology

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“…If the observer stands in the nonadjacent sinus and faces the pulmonary trunk then the right coronary artery will originate to the right hand of the observer, from the right hand sinus, or “sinus 1” The left coronary artery will arise to the left hand of the observer, from the left hand sinus, or “sinus 2” (Fig. ; Anderson, ; Loukas et al, ; Loukas et al, a; Loukas et al, in press).…”

Section: Embryology and Anatomymentioning

confidence: 99%

The clinical anatomy of high take‐off coronary arteries

et al. 2015

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A number of criteria are used in the literature to describe high take-off coronary arteries, which can in part, explain the divide in the literature on the pathological significance of this anomaly. This study presents the anatomical variations of high take-off coronary arteries to draw attention to the possible clinical implications they may cause during angiography and other surgical procedures. The English Literature was searched to review high take-off coronary arteries. A high take-off coronary artery arising at least 1 cm in adults or 20% the depth of the sinus in children above the sinutubular junction, is considered of greater clinical relevance and was included in our meta-analysis. High take-off coronaries by other criteria was also included as part of the comprehensive review. Exclusion criteria were reports made in case studies or case reviews. The prevalence of high take-off coronary arteries in our study was 26 of 12,899 (0.202%). High take-off coronary arteries were found to originate up to 5 cm above the sinutubular junction. Right coronary arteries made up 84.46% of high take-off coronary arteries reported in the literature. Three (0.023%) cases that originated more than one centimeter above the sinutubular junction was associated with sudden cardiac death. This is a higher reported association than in studies that used other criteria for classification. It is important for clinicians to recognize the importance of correctly diagnosing high take-off coronary arteries in patients with coexisting cardiac morbidities so that suitable management plans can be developed.

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“…Unlike the free‐standing pulmonary root, which is supported entirely by ventricular myocardium, parts of two of the aortic leaflets are in fibrous continuity with the leaflets of the mitral valve (Loukas et al. ), with part of the root also in connection with the membranous part of the ventricular septum. Surprisingly little is known about the cellular origins and processes involved in the development of the supporting structures of the arterial roots.…”

Section: Introductionmentioning

confidence: 99%

Development and maturation of the fibrous components of the arterial roots in the mouse heart

et al. 2017

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The arterial roots are important transitional regions of the heart, connecting the intrapericardial components of the aortic and pulmonary trunks with their ventricular outlets. They house the arterial (semilunar) valves and, in the case of the aorta, are the points of coronary arterial attachment. Moreover, because of the semilunar attachments of the valve leaflets, the arterial roots span the anatomic ventriculo‐arterial junction. By virtue of this arrangement, the interleaflet triangles, despite being fibrous, are found on the ventricular aspect of the root and located within the left ventricular cavity. Malformations and diseases of the aortic root are common and serious. Despite the mouse being the animal model of choice for studying cardiac development, few studies have examined the structure of their arterial roots. As a consequence, our understanding of their formation and maturation is incomplete. We set out to clarify the anatomical and histological features of the mouse arterial roots, particularly focusing on their walls and the points of attachment of the valve leaflets. We then sought to determine the embryonic lineage relationships between these tissues, as a forerunner to understanding how they form and mature over time. Using histological stains and immunohistochemistry, we show that the walls of the mouse arterial roots show a gradual transition, with smooth muscle cells (SMC) forming the bulk of wall at the most distal points of attachments of the valve leaflets, while being entirely fibrous at their base. Although the interleaflet triangles lie within the ventricular chambers, we show that they are histologically indistinguishable from the arterial sinus walls until the end of gestation. Differences become apparent after birth, and are only completed by postnatal day 21. Using Cre‐lox‐based lineage tracing technology to label progenitor populations, we show that the SMC and fibrous tissue within the walls of the mature arterial roots share a common origin from the second heart field (SHF) and exclude trans‐differentiation of myocardium as a source for the interleaflet triangle fibrous tissues. Moreover, we show that the attachment points of the leaflets to the walls, like the leaflets themselves, are derived from the outflow cushions, having contributions from both SHF‐derived endothelial cells and neural crest cells. Our data thus show that the arterial roots in the mouse heart are similar to the features described in the human heart. They provide a framework for understanding complex lesions and diseases affecting the aortic root.

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The anatomy of the aortic root

Cited by 42 publications

References 26 publications

Heart Valve Biomechanics and Underlying Mechanobiology

Heart Valve Biomechanics and Underlying Mechanobiology

The clinical anatomy of high take‐off coronary arteries

Development and maturation of the fibrous components of the arterial roots in the mouse heart

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