Bicuspid aortic valve, the most common congenital cardiac defect, is often associated to ascending aorta and root dilation. Since commissural orientation <160° is one of the principal risk factors for recurrent aortic insufficiency, our systematic approach consists of reimplantation with 180°-180° geometric configuration associated to aortic leaflets repair.
The valve was bicuspid due to right-left coronary cusps fusion with a fibrotic raphe. Raphe and leaflets free margin shaving was performed within the native aortic root intact to improve cusp mobility and restore a normal motion. Reimplantation procedure was performed in the conventional fashion except for the peculiarity that the valve resuspension started with fixation of the two commissures in a 180°-180° symmetric configuration within the neo-root (Valsalva graft n.28) to the new predetermined sinotubular junction. Before completion of the surgery, the valve was re-assessed to correct any residual prolapse: both leaflets needed plicature.
1Cardiochirurgia, ASST Fatebenefratelli-Sacco Milano
2Università degli Studi di Milano Milano