Aortic Valve

Introduction
The aortic valve is a valve made up of three membranes made up mainly of
collagen; the valve is placed on a muscle ring and connected through it to
the heart wall.

Structure
The aortic valve is a semilunar valve that generally has three leaflets.

The leaflets of the aortic valve connect to the aortic root via the aortic
annulus.

The aortic valve is often described relative to the aortic root.

The aortic root consists of the left ventricular outflow tract until it meets with
the ascending aorta.

The following descriptions detail the anatomy of the aortic root as they
relate to the aortic valve.

Annulus The aortic annulus serves as an anchor point for the valve.

It continues directly with the aortic leaflet of the mitral valve.

Sinus of Valsalva The aortic sinuses are also called the sinus of Valsalva,
named after Italian anatomist Antonio Valsalva.

They function to ensure that the aortic leaflets do not occlude the Ostia of
the coronary arteries during systole.

In the non-coronary sinus, the base consists of a fibrous piece that

continues from the aortic and mitral valves.

The sinotubular junction also marks the top of the attachments of the aortic
leaflets.

Functions
When the pressure in the ventricle is greater than that of the aorta, the
aortic valve leaflets open, allowing blood to exit the ventricle and enter the
ascending aorta.

Conversely, the aortic valve leaflets close when the left ventricle pressure
decreases to less than that of the ascending aorta; this typically occurs
during diastole.

The sinuses ensure that the ostia of the coronary arteries are not occluded
when the aortic valve leaflets are open.

The aortic valve begins as a swelling of the endocardial cushions.

Endothelial cells and vascular smooth muscle cells will form the aortic root
and aortic valve; this is the result of the embryological collaboration
between the splanchnic mesoderm and the neural crest, deriving from the
second heart field.

Blood Supply and Lymphatics

Heart valves are metabolically active, as is the aortic valve; the cusps
contain blood vessels for oxygen supply and removal of metabolic waste.

The nerve fibers that go to the aortic valve derive from the ventricular
endocardial plexuses and others to a lesser extent, from the aortic
adventitial wall.

Muscles
The aortic valve, unlike the mitral valve, has no associated papillary
muscle.
One percent of the population has an aortic valve with only two leaflets.

This condition is referred to as a bicuspid aortic valve.

Possible complications of a bicuspid aortic valve include aortic stenosis or

aortic regurgitation, usually due to early calcification.

The presence of a quadricuspid aortic valve has a very rare percentage of

findings, but it can be found during an ultrasound or a more invasive
examination such as a transesophageal examination.

Surgical Considerations
Balloon valvuloplasty or aortic valve replacement are indicated procedures
for symptomatic aortic stenosis or aortic regurgitation.

Cardiac surgery on the aortic valve falls into two basic groups: those of
"Plastic" or "Repair," which maintains the native valve; and "Replacement"
interventions, in which the valve is replaced with a prosthesis.

Aortic plastic interventions consist of the repair of the valve to correct its
pathology without replacing it.

Clinical Significance
Aortic stenosis is defined as the narrowing of the aortic valve to impair
blood flow out of the left ventricle and can be confirmed by
echocardiogram.

The most common cause of aortic stenosis is due to age-related reasons

such as a calcified aortic valve.

The aortic stenosis, if left untreated, can lead to left ventricular hypertrophy.

Severe aortic stenosis is a serious medical condition, and valve

replacement is usually indicated in eligible patients.

Aortic regurgitation is the retrograde flow of blood from the aorta into the
left ventricle.

The prevalence of aortic regurgitation is estimated at 4.9% and increases

with age until the sixth decade.

Aortic regurgitation is also a common finding in patients who also have

aortic stenosis.

On physical exam, aortic regurgitation can be suspected due to wide pulse

pressure, an early diastolic murmur The murmur associated with aortic
regurgitation is usually referred to as a diastolic decrescendo murmur.

Aortic regurgitation can be auscultated as an early diastolic murmur.

An Austin Flint murmur may be auscultated in some cases of aortic

regurgitation.

Like aortic stenosis, aortic regurgitation can present with symptoms of heart
failure as well.

Similar to aortic stenosis, the etiology of aortic regurgitation is most

impacted by age and congenital abnormalities, such as a bicuspid valve.

Rheumatic fever is a common risk factor for aortic regurgitation The acuity
and severity of the regurgitation are the primary drivers for management.
Figure 1. Cardiac, Valves of the Heart, Bicuspid Valve, Aortic Valve,
Pulmonary Valve, Tricuspid Valve, Right Coronary Artery,. Contribute by
Gray's Anatomy Plates
Figure 2. Trans Sagittal Cross section of the Heart, Aorta, Left Auricula,
Aortic Valve, Papillary muscles, Left Ventricle, Bicuspid Valve, Ventricular
Septum, Inferior Vena Cava, Membranous septum, Musculi pectinati,
Anterior Papillary Muscles, Tricuspid Valve. Contributed by Gray's Anatomy
Plates.
Figure 3. Aortic valve stenosis. Image courtesy S Bhimji MD

Reference
Crawford, Phillip T., and Bruno Bordoni. “Anatomy, Thorax, Aortic
Valve.” StatPearls, StatPearls Publishing, 2020. PubMed,
http://www.ncbi.nlm.nih.gov/books/NBK559384/.
Copyright © 2020, Medical Scholar.

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