Conclusion
Asymmetry in tricuspid aortic valves is normal and was present in all
valves we analyzed. Using cut-off criteria for absolute differences in
leaflet dimensions 86% of the valves were classified as asymmetric.
Aligning the leaflet free margin length in standardized aortic valve
repair may not be necessary in tricuspid aortic valve
repair13,14. It seems that in tricuspid aortic valves
the same effective height of the three cups is more important than
identical free margin length, whereas in bicuspid aortic valves,
aligning the free margin length of both leaflets is crucial.
There is a need for the development of surgical techniques that would
respect the asymmetry, particularly in reimplantation and remodeling
procedures. Respecting asymmetry in very asymmetric cases is
mandatory2, whereas in less asymmetric cases it may
reduce the need for leaflet plication and impact long-term results.
Tables
Table 1. Patient data and aortic
valve measurements.