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Expert Consensus Statement: Anatomy, Imaging, and Nomenclature of Congenital Aortic Root Malformations

Lookup NU author(s): Professor Bob Anderson



This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).


© 2023 The AuthorsOver the past 2 decades, several categorizations have been proposed for the abnormalities of the aortic root. These schemes have mostly been devoid of input from specialists of congenital cardiac disease. The aim of this review is to provide a classification, from the perspective of these specialists, based on an understanding of normal and abnormal morphogenesis and anatomy, with emphasis placed on the features of clinical and surgical relevance. We contend that the description of the congenitally malformed aortic root is simplified when approached in a fashion that recognizes the normal root to be made up of 3 leaflets, supported by their own sinuses, with the sinuses themselves separated by the interleaflet triangles. The malformed root, usually found in the setting of 3 sinuses, can also be found with 2 sinuses, and very rarely with 4 sinuses. This permits description of trisinuate, bisinuate, and quadrisinuate variants, respectively. This feature then provides the basis for classification of the anatomical and functional number of leaflets present. By offering standardized terms and definitions, we submit that our classification will be suitable for those working in all cardiac specialties, whether pediatric or adult. It is of equal value in the settings of acquired or congenital cardiac disease. Our recommendations will serve to amend and/or add to the existing International Paediatric and Congenital Cardiac Code, along with the Eleventh iteration of the International Classification of Diseases provided by the World Health Organization.

Publication metadata

Author(s): Tretter JT, Spicer DE, Franklin RCG, Beland MJ, Aiello VD, Cook AC, Crucean A, Loomba RS, Yoo S-J, Quintessenza JA, Tchervenkov CI, Jacobs JP, Najm HK, Anderson RH

Publication type: Article

Publication status: Published

Journal: Annals of Thoracic Surgery

Year: 2023

Volume: 116

Issue: 1

Pages: 6-16

Print publication date: 01/07/2023

Online publication date: 08/06/2023

Acceptance date: 15/03/2023

Date deposited: 06/07/2023

ISSN (print): 0003-4975

ISSN (electronic): 1552-6259

Publisher: Elsevier Inc.


DOI: 10.1016/j.athoracsur.2023.03.023


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