Aortic Root Anatomy

Aortic Root anatomy is the basic mantra of Cardiac Surgery. Without thorough knowledge on this, a surgeon cannot work in the delicate area of heart.

Fig: The aortic root anatomy explained schematically as described in dr. sud’s article

There are three sinus of the aortic valve- Left Coronary Sinus, Right Coronary Sinus and Non coronary Sinus. The Non Coronary Sinus is also known as the Posterior Coronary sinus because of its location. Each sinus has three areas- a central part and two adjacent areas named according the valve cusps they adjoin.

Right Coronary Sinus:  It lies adjacent to the RVOT. The central part lies adjacent to the Crista Supraventricularis. Left part is in the angle between the crista supraventricularis and the pulmonary valve. The posterior part is posterioroinferior to the crista supraventricularis.  Left part is related to the muscular part of the inter ventricular septum where as the central and the inferior part is related to either the muscular or the membranous part of inter ventricular septum.

Non Coronary Sinus:  The right and central part of the non coronary sinus are related to the right atrium and the interatrial septum. The left part is related to left atrium. Inferiorly, the right part related to the membranous or the muscular septum. Beneath the central part the membranous septum is always present. The left part inserts into the anterior mitral leaflet.

Left Coronary Sinus:  Posterior part is related to the left atrium posteriorly and to the anterior mitral leaflet inferiorly. Central part of the left coronary sinus is the only part of the aortic root that is not related to a cardiac chamber, it is adjacent to the epicardium only. The right part lies adjacent to the pulmonary trunk  and inferior to it lies the muscular inter ventricular septum.

A concrete knowledge on the aortic root anatomy can help the surgeon for aortic root enlagement procedure or during the closure of the ventricular septum in TOF and carefulness for the complications it can lead to.

 

 

 

 

 

Heart Chamber Pressures

Diagnosis of heart diseases has been revolutionised after the discovery of cardiac catheterisation. It simply works wonder after proper pressure measurement of all cardiac chambers.

Interventional cardiologist cam cure almost half of the heart diseases beginning from congenital cardiac issues to the adult percutaneous coronary intervention by stent placement. Now percutaneous valve placement and pemnanet pacemaker implantation has kept to-be-dead people alive.

Cardiac catheterisation can be right heart catheterisation or left heart catheterisation depending on the need of suspicious diagnosis or both if required, and in complex cases it needs both.

Coronary angiography after an ECG changes can clearly diagnose the disease with aortogram with root shot of dye in aorta.

To keep the chapter short and brief almost all cardiac condition can be diagnosed with cardiac catheterisation. Pressure tracing is an important part of it with consideration of saturation in congenital cases.

Elevated RA pressure:

  • Tricuspid stenosis – large ‘a’ wave
  • Tricuspid regurgitation- large ‘v’ wave
  • RV dysfunction-pulmonary hypertension, RV infarction
  • Constrictive pericarditis
  • Tamponade
  • Restrictive disease

Elevated RV pressure:

  • RV dysfunction ( pulmonary hypertension, RV infarct)
  • Constrictive pericarditis ( square root sign; rapid x and y descent)
  • Restrictive disease
  • Cardiac tamponade ( absent ‘y’ descent)

Elevated PA pressure :

  • Mitral stenosis / Regurgitation
  • LV systolic or diastolic dysfunction ( ischaemic, dilated cardiomyopathy, aortic stenosis/regurgitation)
  • Pulmonary hypertension of other etiologies
  • Constrictive pericarditis / tamponade / restrictive disease

Elevated PCW pressure:

  • Mitral stenosis ( large ‘a’ wave if sinus rhythm)
  • Mitral regurgitation ( large ‘v’ wave)
  • LV systolic or diastolic dysfunction ( ischemic, dilated cardiomyopathy, aortic stenosis/regurgitation)
  • Constrictive pericarditis/tamponade

Elevated LVEDP:

  • LV systolic or diastolic dysfunction ( ischemic, dilated cardiomyopathy, aortic stenosis/regurgitation)
  • Constrictive pericarditis/tamponade.

So long as we manage or play safe with pressures and numbers we are safe and sure of what we treat.