**1. Introduction**

The impetus behind preservation of the native aortic valve derives from the desire to avoid the inherent shortcomings of prosthetic valves. These include the requirement for long term anticoagulation in the case of mechanical valves, and tissue degeneration with the need for re-operations with bioprostheses. Aortic valve preservation in the setting of aortic root dilatation is technically challenging, however potentially rewarding if these benefits can be achieved. This enthusiasm for aortic valve preservation must of course be tempered by the potential risks of residual or recurrent significant aortic regurgitation and subsequent complex re-operations associated with repair failures.

Appreciation of the complex three-dimensional anatomy of the normal aortic root and how it changes in pathological states is essential to facilitate reconstruction.

*Reprinted from Heart, Lung and Circulation, 2004;13 Suppl 3, Matalanis G, Valve sparing aortic root repairs--an anatomical approach. S13-18., Copyright (2004), with permission from Elsevier* 

Fig. 1. The aortic valves, leaflets and adjacent aortic root structures, which participate in normal aortic valve function
