The surface anatomy of the human aortic valve as revealed by scanning electron microscopy.

The anatomy of the human aortic valve was studied by SEM in 36 subjects without cardiac pathology who had died of various accidental causes. Villous and lamellar tissue excrescences were observed at the node of Arantius and at the limit between the lunules and the load-bearing portion of the leaflets. The morphology of these structures suggests that they represent areas in which valve tissue becomes detached into the bloodstream. Fenestrations were present in the lunules of 14 specimens, with a higher incidence in specimens from subjects who were middle-aged or older. Our observations suggest that fenestrations appear initially as small perforations which then coalesce to form larger apertures. Two main types of endothelial cells, elongated and polygonal were detected on the endothelial surface of the leaflets. Both types of cells display a constant mode of arrangement on the different segments of the leaflets (lunules, node of Arantius and load-bearing portion of the leaflet). The possible relationships between endothelial cell morphology and the pattern of mechanical stress to which the leaflets are subjected is discussed.