The aortic root hexagon as an aide memoire to the important surgical landmarks

The anatomy of the aortic root and its relationship to cardiac landmarks is important for valve-sparing surgery and understanding the pathology of lesions arising in this structure. Rapid understanding of the key anatomical details can be achieved by a geometrical concept based on the shape of a hexagon.

Definitions, structure, and key anatomical concepts of the aortic root according to the current literature were reviewed. Thirty pig hearts were dissected to explore the relationships of the six points on the aortic root. Six double 2/0 ethibond needles were placed into the six points at 90°. The passage of the needles through the specific cardiac landmarks at each point was noted. The aortic root hexagon is a geometrical structure formed by two triangles superimposed on each other. The six points in the hexagon relate to important adjacent cardiac landmarks.

The two best-known anatomical relationships are of the left-non coronary aortic commissure to the longitudinal axis of symmetry of the aortic leaflet of the mitral valve and the relationship of the nadir of the noncoronary aortic valve leaflet to the medial commissure of the mitral valve. The other four points are related to equally significant and well defined anatomical landmarks.

The aortic root hexagon is made by two triangles superimposed on each other, these are the commissural and nadir triangles respectively. We have found this concept to be a quick way to learn and remember the key anatomical relationships of the aortic root.