Geometry of cusp and root determines aortic valve function

Abstract

The aortic valve is the functional unit of cusp and root. Various geometrical and functional analyses for the aortic valve unit have been executed to understand normal valve configuration and improve aortic valve repair. Different concepts and procedures have then been proposed for reparative approach, and aortic valve repair is still not standardized like mitral valve repair. It has become apparent, however, that interpretation of the geometry of the aortic cusp and root and its appropriate application to operative strategy lead to creating a functioning aortic valve. Herein, the aortic valve geometry and its clinical implications are reviewed to provide information for the selection of appropriate operative strategies.

Keywords: Aortic valve geometry; Aortic valve repair; Cusp effective height.

Fig. 1

Normal aortic valve configuration. a Diagrammatic representation. b Schematic drawing, modified from Schäfers 2013 [8]. (eH effective height, gH geometric height)

Fig. 2

Diagrammatic representation of aortic valve morphology and schematic drawing of cusp insertion line, modified from Schäfers 2008 [9]. a Tricuspid aortic valve. b Bicuspid aortic valve. c Unicuspid aortic valve. (LC left coronary sinus, NC noncoronary sinus, RC right coronary sinus)

Fig. 3

Prolapsed aortic valve configuration. a Diagrammatic representation. b Schematic drawing, modified from Schäfers 2013 [8]. (eH effective height; gH geometric height)

Fig. 4

Correlation between aortic valve configuration and each geometrical determinant. a With different geometric height, modified from Marom 2013 [24]. b With different virtual basal ring diameter, modified from Marom 2013 [25]. c With different sinotubular junction diameter, modified from Marom 2013 [26]