Genevieve Carbonatto
The aortic valve is the centrepiece of the heart
It lies between the PV, the TV and the MV
It is wedged between the opening of the mitral and tricuspid valves
The normal aortic valve consists of 3 equally sized semilunar leaflets or cusps.
The leaflets form a 3 pronged crown-like structure. The AV consists of
- A virtual ring formed by the hinge points of the leaflets attached within the left ventricle. This is the inlet of the left ventricular outflow tract.
- A true ring which is the sinotubular junction. This is the outlet of the aortic root into the ascending aorta
- The spaces between the luminal surface of the three bulges on the aortic root and their respective valvular leaflets are the aortic sinuses of Valsalva. The sinuses are named according to the arteries arising within them. Right coronary artery from the right sinus of Valsalva, left coronary artery from the left sinus of Valsalva. The leaflet associated with the sinus which does not have a coronary artery is called the non coronary cusp and is adjacent to the interatrial septum
- The 3 leaflets of the aortic valve have a free margin and a margin attached in semilunar fashion to the aortic root. When the valve opens the leaflets fall into their respective sinuses
- Any disruption congenital or acquired of the structures within the aortic root will have potential significant clinical consequences
- 3 interleaflet fibrous triangles extend from the LVOT to the sinotubular junction. They are formed by the fibrous wall of the aorta
- Apices of these triangles represent potential communication with the pericardial space and becomes the entry point for blood into the pericardial space
- The interleaflet triangles are thinner than the hinge points or the sinus walls and therefore more likely to become aneurysmal
The aortic root
The aortic root is defined as the cylindrical area between the aortic annulus and the sinotubular junction
- It is an extension of the LVOT
- It extends from the aortic annulus to the sinotubular junction
- The sinus of Valsalva is comprised of 3 aortic sinuses 2 of which give rise to the coronary arteries
- The aortic root “ balloons out” at the midpoint of the sinus of Valsalva
The aortic root is therefore anatomically part of the aortic valve.
The aortic valve therefore consists of
1. the attachment of the leaflets at the aortic annulus
2. the sinuses of Valsalva
3. sinotubular junction
In summary
- The aortic valve is made up of 3 semilunar valves
- The aortic root is an integral part of the anatomy of the aortic valve
- Any pathology that affects the aortic root will have a potential effect on the function of the aortic valve