Microstructure of the juvenile sheep aortic valve hinge region and the trilamellar sliding hypothesis

Background: The aortic valve mechanism performs extremely sophisticated functions which depend on the microstructure of its component parts. The hinge mechanism of the aortic leaflets plays a crucial part in the overall function. However, the detailed microstructure and its relation to function has not been adequately studied. Methods: The aortic roots of juvenile sheep were fixed under physiologic pressure. Sections through all three sinuses were then performed to illustrate the microstructure of the hinge mechanism in different regions of the aortic root. Results: The hinge region in the different sinuses showed unique microstructure with a trilamellar topology with a dominant core consisting of glycosaminoglycans. The exact arrangement of the trilamellar structures varies around the aortic sinuses, which could have functional implications. These features allow the hinge to perform its complex functions through what we have described as “the trilamellar sliding hypothesis”. Conclusion: The microstructure of the hinge mechanism is unique and enables it to perform it sophisticated functions.