The need for precision when describing the aortic root

Our commentary addresses the issues raised with two manuscripts published in the Special Issue of the Journal edited by Professor de Paulis about the surgical approach to the aortic root. It is unquestionable that appropriate surgical treatment requires a detailed understanding of the underlying anatomy. In the first article, Professor de Paulis et al. shows the anatomical precision that can now be achieved using computed tomography. In the second article, the same group shows how an appreciation of this anatomy dictates their surgical approach. In our commentary, we highlight that the terms used in the two manuscripts indicate that the confusion identified in a questionnaire organized in 2012 about terminological issues remains unresolved, in particular regarding the definition of the enigmatic valvar “annulus”. We provide anatomical illustrations that demonstrate the ongoing problems. We also emphasize that bisecting planes of the root, rather than off-center cuts, should be used when taking the measurements of the components of the root that help the surgeon make the optimal repair. We finish by stressing the need for equal specificity in the words used to describe the components, pointing out that “cusp” is inadequate as a synonym for the valvar leaflets, especially since more often the valvar sinuses are described as “cusps”.