Anatomy and pathophysiology of the ventriculo-aortic junction: implication in aortic valve repair surgery.

Abstract

Listen

Translate article

To understand the different mechanisms of aortic regurgitation (AR), the aortic valve needs to be considered as a functional unit composed of three structures: (I) the functional aortic annulus (FAA), comprising of the ventriculo-aortic junction (VAJ) and the sino-tubular junction (STJ) (Figure 1); (II) the leaflets with their attachment; and (III) the three sinuses of Valsalva. The different mechanisms of AR have been classified by our group in a repair-oriented classification, with particular importance given to the VAJ. Generally, along with the primary repair technique specific for each type of AR, a VAJ annuloplasty is required to restore the discrepancy between valve orifice and quantity of leaflet tissue (Figure 2) (1,2). Figure 1 Diagrammatical representation of the aortic root. a. sinotubular junction; b. Ventriculo-aortic junction, also called basal ring or surgical annulus; c. the sinuses of Valsalva Figure 2 Repair-oriented functional classification of aortic insufficiency (AI) with description of disease mechanisms and repair techniques used. FAA, functional aortic annulus; STJ, sinotubular junction; SCA, subcommissural annuloplasty In this review, we focus on the VAJ as a part of the FAA. We emphasize the role of the VAJ in the development of AR and the need for VAJ annuloplasty in AV repair. We describe the anatomy of the VAJ and the dynamics during the cardiac cycle. We also define its dimensions in normal and pathological aortic valve (AV). Finally, we analyze the different surgical solutions for VAJ annuloplasty.