Morphology of the pulmonary and aortic roots with regard to the pulmonary autograft procedure.

Aortic root replacement with the pulmonary autograft warrants a thorough histologic comparison of the morphologic characteristics of the pulmonary and aortic roots. For this purpose nine normal heart specimens (7 neonatal and 2 adult hearts) were studied. Histologic study confirmed the collagenous anulus in both roots to be a complex circular-shaped structure, intricately interposed between the elastic lamellae of the arterial wall and the ventricular structures of the heart. In this sinus the elastic lamellae of the arterial wall continue along the luminal side with collagen being situated at the outside. At the interleaflet triangle this relation is reversed. Surprisingly, islet of elastic fibers were found in the otherwise completely collagenous interleaflet triangles. The amount of elastic lamella distal to the commissures was in both arteries higher than that in the middle of the sinuses, with a preponderance in the aorta as compared with the pulmonary trunk. The pulmonary root anulus proximally inserts into the relatively thin right ventricular myocardium, whereas the aortic root anulus inserts into the thick left ventricular myocardium and several fibrous structures. The pulmonary root is hardly supported by the right ventricular myocardium, whereas the aortic root is supported by its wedged position between the left and right atrioventricular anuli and the bulging thick left ventricular myocardium. When the pulmonary autograft is used for aortic root replacement it should be inserted as proximally as possible to get the support of the fibrous structures of the left ventricular outflow tract and the surrounding ventricular and atrial myocardium.