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.