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.