Dawn S. Hui, MD
Central Message.
Much as advances in clinical imaging have informed surgical approaches, innovative visual educational tools are useful to enhance understanding of bicuspid aortic valve structural relationships.
See Article page 44.
The simplistic definition of bicuspid aortic valve (BAV) as a semilunar valve with 2 leaflets belies the complexity of this condition. Despite being the most common cardiac valvular abnormality, BAV in many ways remains a mystery. The underlying molecular mechanisms, genetic, and epigenetic phenomena of nonsyndromic BAV and associated aortopathy remain areas of ongoing investigation. In parallel to the deepening scientific understanding of these areas, surgeons have led the way to a more comprehensive understanding of the anatomy of the aortic valve and root in BAV. This is necessary to address the surgical challenges of correcting what is not a uniformly phenotypic expression.1
While all BAV have in common 2 leaflets, it is a variable condition, with phenotypic variation in leaflet morphology, cusp fusion length, commissure height, and commissural angles. In this edition of Techniques, Woo and colleagues2 elegantly demonstrate these anatomic relationships in the varying subtypes of BAV. Much as advanced imaging techniques such as echocardiography and computed tomography have informed our knowledge of BAV anatomy, this videographic, although simple, adds a layer of understanding that may inform aortic valve repair techniques. Of particular relevance is the implication for valve-sparing root replacement in Sievers type I BAV. Whether to maintain the native commissural orientation or to place the commissures at a 180°/180° versus native orientation remains an area of investigation. Unequal commissure heights have implications for reimplantation, and the degree of cusp fusion affects native leaflet quality and mobility.3,4 Finally, although the video depicts the structural relationships, it does not portray important aspects of pathology, such as leaflet prolapse or important tenets of repair such as effective height. However, it provides a solid foundation and framework on which surgeons and scholars of bicuspid aortic valve disease can begin to understand such matters.
Footnotes
Disclosures: The author reported no conflicts of interest.
The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.
References
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