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Editorial
. 2021 Jan 29:7:83-92.
doi: 10.1016/j.xjtc.2020.12.043. eCollection 2021 Jun.

Commissural geometry and cusp fusion insights to guide bicuspid aortic valve repair

Jama Jahanyar  1 , Gebrine El Khoury  1 , Laurent de Kerchove  1
Affiliations
Editorial

Commissural geometry and cusp fusion insights to guide bicuspid aortic valve repair

Jama Jahanyar et al. JTCVS Tech. .
No abstract available

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Figures

None
Our new repair-oriented BAV classification. Range of commissural orientation 120° to 180°.
Figure 1
Figure 1
Our new repair-oriented BAV classification. Range of commissural orientation 120° to 180°. BAV, Bicuspid aortic valve.
Figure 2
Figure 2
Repair-oriented classification of bicuspid aortic valve (BAV) phenotypes. Upper panel, Raphe height. Middle panel, Respective commissural orientation and raphe fusion. Lower panel, Surgical view of native valve.
Figure 3
Figure 3
Illustration of measurements of interest in bicuspid aortic valve (BAV) repair. Transesophageal echocardiographic assessment of commissural orientation (CO). Intraoperative measure of geometric height (gH) of fused cups (fc) and nonfused cusp (nfc) and length of cusp fusion line (LF); height of raphe (RH) and commissures (CH) in BAV.
Figure 4
Figure 4
Upper panel, transesophageal echocardiography assessment of commissural orientation on short axis in diastole; view from underneath the valve. Lower panel, Respective surgical view from above the valve.
Figure 5
Figure 5
Deep root dissection below the level of the ventriculo-aortic junction (VAJ) (dotted line), with separation of right- and left-ventricular outflow tracts. Placement of annuloplasty sutures at the level of the basal ring (interventricular septum [yellow arrows]).
Figure 6
Figure 6
Placement of basal ring sutures in bicuspid aortic valve (BAV). Selective annuloplasty to achieve symmetry at the level of the basal ring, which also sets up correct 180° placement of the commissures (Valsalva graft [yellow ring]).
Figure 7
Figure 7
Symmetric phenotype; requires central plication with 180° reimplantation technique. A and B, One hundred seventy-degree bicuspid aortic valve (BAV) repaired with 180° reimplantation technique. C and D, One hundred sixty-degree BAV repaired with central plication of fused cusp and 180° reimplantation technique.
Figure 8
Figure 8
Asymmetric phenotype. (A-D) A, One hundred fifty-degree bicuspid aortic valve (BAV) with fusion right/left-cusp. B, Central plication with raphe thinning. C, Direct closure of unfused segment of fused cusp. D, One hundred eighty-degree reimplantation technique with plication of the nonfused cusp. (E-H) E, One hundred fifty-degree BAV with fusion of right/left cusps. F and G, Raphe thinning with direct closure. H, One hundred eighty-degree reimplantation technique. (I-L) I, One hundred forty-degree BAV with fusion of right/left-cusps. J, Central plication with raphe thinning. K, Direct closure of unfused segment of fused cusp. L, One hundred eighty-degree reimplantation technique with plication of the nonfused cusp.
Figure 9
Figure 9
Very asymmetric phenotype requires a very tailored approach. In general, the 120° configuration is kept, and a new functional commissure is created by different techniques. A and B, Type fruste with commissurotomy, right coronary cusp central plication, and 120° reimplantation. C and D, Commissure resuspension. E and F, Commissurotomy and leaflet thinning. G and H, Commissure reconstruction with butterfly pericardial patch.
Figure 10
Figure 10
Very asymmetric fenestrated chord type. A through D, Cord resection, raphe direct closure. E through H, Cord resection, raphe direct closure, and 180° reimplantation technique.
See this image and copyright information in PMC

Comment in

  • New horizons in aortic valve repair.
    Woo YJ. Woo YJ. JTCVS Tech. 2021 Apr 26;7:71. doi: 10.1016/j.xjtc.2021.04.018. eCollection 2021 Jun. JTCVS Tech. 2021. PMID: 34471910 Free PMC article. No abstract available.

Comment on

References

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