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J Thorac Cardiovasc Surg 1997;114:870
© 1997 Mosby, Inc.

LETTERS TO THE EDITOR

The structure of the aortic root

Section of Pediatrics
National Heart and Lung Institute
Imperial College School of Medicine
Dovehouse St.
London SW3 6LY, United Kingdom

To the Editor:

Hokken and associates ¹ describe important histologic findings concerning the structure of the ventricular outflow tracts. In this report, they make reference to our comments made in 1991 ² concerning the aortic "anulus." It is unfortunate in this respect that they chose to ignore more recent work in which we ³ described in detail the collagenous condensations at the point of attachment of each leaflet which, as we indicated, "has been termed the annulus fibrosus." Had they studied this work, they would also have noted that we described the "very thin layer of elastic tissue" to be found on the luminal surface of the interleaflet triangles, a finding for which they claim precedence.

Such matters pale into insignificance, however, with their suggestion that the subpulmonary infundibulum is made up, in part, of the right ventricular septum. In this respect, we presume that, when describing a septum, they account for a wall that separates adjacent cardiac cavities. As is widely recognized by all surgeons who perform the Ross procedure, the essential feature that permits the subpulmonary infundibulum to be removed, along with its contained valve, as an autograft is that it does not possess a septal component. This can be readily demonstrated by dissections (Fig. 1), but should also have been evident from their histologic sections. The fact that the pulmonary valve leaflets are supported by a freestanding muscular sleeve, whereas the sinotubular junctions are joined in some hearts by the conus ligament, is a fact that should intrigue the Leiden group in terms of embryogenesis. It is certainly not something that should be obscured by description of a "septal" component to the infundibulum.

12/8/84947

References

1. Hokken RB, Bartelings MM, Bogers AJJC, Gittenberger-de Groot AC. Morphology of the pulmonary and aortic roots with regard to the pulmonary autograft procedure. J Thorac Cardiovasc Surg 1997;113:453-61. [Abstract/Free Full Text]
   
2. Anderson RH, Devine WA, Ho SY, Smith A, McKay R. The myth of the aortic annulus: the anatomy of the subaortic outflow tract. Ann Thorac Surg 1991;52:640-66. [Abstract]
   
3. Sutton JP III, Ho SY, Anderson RH. The forgotten interleaflet triangles: a review of the surgical anatomy of the aortic valve. Ann Thorac Surg 1995;59:419-27. [Abstract/Free Full Text]
   

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Robert H. Anderson Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Anderson, R. H. Search for Related Content PubMed PubMed Citation Articles by Anderson, R. H.