Toggle Main Menu Toggle Search

Open Access padlockePrints

The atrioventricular conduction axis and the aortic root—Inferences for transcatheter replacement of the aortic valve

Lookup NU author(s): Professor Bob Anderson


Full text for this publication is not currently held within this repository. Alternative links are provided below where available.


© 2021 American Association of Clinical Anatomists.Conduction problems still occur following transcatheter aortic valvar replacement. With this in mind, we have assessed the relationship of the conduction axis to the aortic root. We used serial histological sections, made perpendicular to the base of the triangle of Koch in nine hearts, and perpendicular to the aortic root in 11 hearts. We first defined the extent of the fibrous tissues forming the boundaries of an infero-septal recess of the subaortic outflow tract, found in all datasets but one. When the recess was present, the axis penetrated through its rightward wall, giving rise to the left bundle branch prior to entering the outflow tract. The axis itself was usually on the crest of the ventricular septum, but could be deviated leftward or rightward. Its proximity to the virtual basal plane reflected the angulation of the muscular septum. On average, the superior edge of the left bundle was within 3.3 mm of the hinge of the right coronary leaflet, with a range from 0.4 to 10.2 mm. The arrangement was markedly different in the case lacking an infero-septal recess. Our findings necessitated a redefinition of the right fibrous trigone and the central fibrous body. The atrioventricular conduction axis, having entered the aortic root, is usually closest at the hinge of the right coronary leaflet. Knowledge of the depth of the infero-septal recess, and the angulation of the muscular ventricular septal, may help to avoid conduction problems following transcatheter implantation of the aortic valve.

Publication metadata

Author(s): Macias Y, Tretter JT, Sanchez-Quintana D, Cabrera J-A, Spicer DE, de Almeida MC, Anderson RH

Publication type: Article

Publication status: Published

Journal: Clinical Anatomy

Year: 2022

Volume: 35

Issue: 2

Pages: 145-154

Print publication date: 01/03/2022

Online publication date: 28/09/2021

Acceptance date: 22/09/2021

ISSN (print): 0897-3806

ISSN (electronic): 1098-2353

Publisher: John Wiley and Sons Inc


DOI: 10.1002/ca.23793


Altmetrics provided by Altmetric