The aortic outflow and root: A tale of dynamism and crosstalk

Although the aortic outflow and root (AoR) constitute a short channel connecting the left ventricle to the aorta, its different components have been shown to be highly specialized structures, interacting with each other as well as with surrounding structures, thus providing a 'tale of dynamism and crosstalk.' Thorough knowledge of the AoR and morphological and structural changes, that occur during pathological processes, can have important implications in evolving and executing surgical procedures designed to preserve and restore the 'dynamism and crosstalk.' The crown-shaped annulus, fibrous trigones, aortic cusps components, aortic sinuses, and the sinotubular junction share a dynamic coordinated behavior, which can be partially or completely restored in various repair or replacement procedures of the AoR. The interaction and the specific operations are presented with evidence supporting the notion that the dynamic behavior of the root does influence the pattern of instantaneous movements of the aortic cusps after different types of operations. Further studies are required to evaluate the influence of adopting these ideas on the long-term results of operative procedures.