SURGICAL ANATOMY OF AORTIC VALVE
- After the sternum is retracted and the presternal fat tissue is dissected away, the anterior sheath of the pericardium is brought into the sight.
- The pericardial incision begins just inferior to the brachiocephalic vein.
- In the superior part of the pericardium, the incision runs between the pulmonary artery and the aortic root.
- Inferiorly, the pericardial incision is extended to a point two finger-breaths over the diaphragm.
- From here on, the incision is extended on the right toward the inferior vena cava and on the left toward the left apex.
- The edges of the pericardium are fixed with pericardial stitches to the sternal spreader.
- The aortic root is located behind the right lateral wall of the infundibulum.
- It is very important to realize that the aortic root and the superior vena cava are not in the same plane. The vein is superficial relative to the aortic root.
Anterior sheath of the pericardium, as seen following median sternotomy