The Normal Aortic Valve
Pp. 3-20 (18)
Wilhelm P. Mistiaen
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.
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.
Artesis University College Antwerp Department of Healthcare Sciences, University of Antwerp, Belgium