1. Pericardial Patch Augmentation for Reconstruction of Incompetent Bicuspid Aortic Valves 
Mirko Doss, MD, Reinhard Moid, MD, Jeffrey Paul Wood, MD, Aleksandra Miskovic, MD, Sven Martens, MD, Anton Moritz, MD 
The Annals of Thoracic Surgery 
Volume 80, Issue 1, Pages (July 2005)
DOI: /j.athoracsur
Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

2. Fig 1
Principle of the pericardial patch augmentation technique. (Left) Native bicuspid aortic root with prolapsing fused leaflet and displaced base of the nonfused leaflet. (LVOT = left ventricular outflow tract.) (Right) The free edge of the fused leaflet is enhanced by a glutaraldehyde-fixed pericardium, and competence of the valve is achieved.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

3. Fig 2
(Left) Nonfused and (right) prolapsing fused leaflets of native bicuspid root, with separation at the commissure. (LCO = left coronary ostium; RCO = right coronary ostium.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

4. Fig 3
The prolapse of the fused leaflet is corrected by a triangular resection. (LCO = left coronary ostium; RCO = right coronary ostium.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

5. Fig 4
A strip of glutaraldehyde-fixed pericardium is sutured to the free edge of the fused leaflet. The augmented fused leaflet is increased in height to maximize the coaptation surface. At the commissures an overlap is created, thereby ensuring optimal coaptation, and thus addressing the commissural separation. (LCO = left coronary ostium; RCO = right coronary ostium.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions