The aortic valve has a deceivingly simple design. However, its macroscopic
anatomy must be understood in relation to its function. This understanding also has a
repercussion on the surgical treatment of aortic valve disease. A supporting structure of a
valve prosthesis does not necessarily follow the line of attachment of the native leaflets.
The aortic root has to be defined properly. It is more than just a ring in a two
dimensional plane. The attachment of the valvular leaflets possesses a three dimensional
structure which changes in shape during the cardiac cycle.
The aortic annulus also needs full description. The diameters at the level of the STJ, the
mid-sinusal level and the anatomic AVJ are part of this concept.
The microscopic and cell biological description of the aortic valve include
- The layers within the leaflets.
- The cells.
o Endothelial cells or EC and their function.
o Valvular interstitial cells or VIC and their function.
- The extracellular matrix.
o The fibers: collagen and elastin.
o The glycosaminoglycans or GAG.
A thorough description of these elements is needed for understanding of:
- The durability of the native valve during an entire human life span.
- The understanding of pathological processes.
- The construction of tissue engineered heart valves or TEHV.
Keywords: Aortoventricular junction, bone morphogenetic protein, collagen,
endothelial cells, extracellular matrix, fibrosa, glycosaminoglycans, left
ventricular outflow tract, nitric oxide, sinotubular junction, spongiosa, valvular
interstitial cells, ventricularis.
