Hans-H. Sievers, MD, Claudia Schmidtke, MD, MBA

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Presentation transcript:

A classification system for the bicuspid aortic valve from 304 surgical specimens Hans-H. Sievers, MD, Claudia Schmidtke, MD, MBA The Journal of Thoracic and Cardiovascular Surgery Volume 133, Issue 5, Pages 1226-1233 (May 2007) DOI: 10.1016/j.jtcvs.2007.01.039 Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Intraoperative picture of a bicuspid aortic valve type 1, L/R, I (see text and Table 1 for explanation) with one completely developed noncoronary cusp, two completely developed commissures (small arrows), and one raphe between the underdeveloped left and right coronary cusps extending to the corresponding malformed commissure (large arrow) with hemodynamic signs of insufficiency due to prolapse of the conjoint cusps. The Journal of Thoracic and Cardiovascular Surgery 2007 133, 1226-1233DOI: (10.1016/j.jtcvs.2007.01.039) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Situs after excision of a bicuspid aortic valve type 1, L/R, I (see text and Table 1 for explanation) showing the underdeveloped and obliterated commissure (arrow) between the left and right coronary cusps. The Journal of Thoracic and Cardiovascular Surgery 2007 133, 1226-1233DOI: (10.1016/j.jtcvs.2007.01.039) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Schematic presentation of the developmental phenotypes of the aortic valve and typical characteristics. Prominent line in schematic drawings represents a raphe, which is the nonseparated or conjoint segment of two underdeveloped cusps extending into the commissural area. *Angelini and associates.21 The Journal of Thoracic and Cardiovascular Surgery 2007 133, 1226-1233DOI: (10.1016/j.jtcvs.2007.01.039) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Intraoperative picture of a “purely” bicuspid aortic valve type 0, lat, S (see text and Table 1 for explanation) with two equal-sized cusps, no raphe, lateral arrangement of the free edge of the cusps, and presenting predominantly with stenosis before (A) and after excision (B). Note that there are only two commissures (arrows). The Journal of Thoracic and Cardiovascular Surgery 2007 133, 1226-1233DOI: (10.1016/j.jtcvs.2007.01.039) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Intraoperative picture of a bicuspid aortic valve type 2, L/R-R/N, S (see text and Table 1 for explanation) with two raphes (arrows) but developmental anlagen of three cusps with a high degree of stenosis. The Journal of Thoracic and Cardiovascular Surgery 2007 133, 1226-1233DOI: (10.1016/j.jtcvs.2007.01.039) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 Age distribution of the 304 patients with a bicuspid aortic valve. The Journal of Thoracic and Cardiovascular Surgery 2007 133, 1226-1233DOI: (10.1016/j.jtcvs.2007.01.039) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure 7 Proportion of an aneurysm of the aortic root or ascending aorta in relation to the type of bicuspid aortic valve. A bicuspid aortic valve type 2 (valve with two raphes) was associated with a significantly (P = .022) higher proportion of aneurysms. The Journal of Thoracic and Cardiovascular Surgery 2007 133, 1226-1233DOI: (10.1016/j.jtcvs.2007.01.039) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure 8 Schemes of bicuspid aortic valve classifications of different authors: A, Sabet and associates4; B, Roberts and associates12; C, Angelini and associates.21 The position of the raphe and cusps, the relative sizes of cusps, as well as the number of sinuses and interleaflet triangles as described from the left ventricular outflow were main but not uniform determinants for classifying bicuspid aortic valves. The Journal of Thoracic and Cardiovascular Surgery 2007 133, 1226-1233DOI: (10.1016/j.jtcvs.2007.01.039) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions