Discussion
Giving the fact that Bicuspid aortic valve (BAV) anomaly is the most common congenital cardiovascular malformation seen in the adult, which can be a stenosed or regurgitant due to the abnormal & unique configuration of this valve anomaly. The reported mean age of developing stenosis is 60 (1). On the other-hand regurgitation associated with bicuspid valve is usually seen in a younger age group; a mean age of 30 (1,2). Aortic dilatation is a superimposed pathology which is seen in about 50% to 60% of the bicuspid valves (3). Reconstruction of the regurgitant BAV was proposed as early as 1992(4). Many studies have shown the safety of BAV repair, and its durability with accepted low mortality rates, less reoperation, and a good long-term survival(5,6). Cusps prolapse due to technical errors in a less optimal repair is one of the common causes of reoperation in these patients; however, natural progression of the disease causing an increase in the valve gradient post repair have been found as a culprit that accounts for a substantial proportion of failure post repair as well (6).
Repair techniques include cusp free margin plication, sub commissural annuloplasty, free margin reinforcement.
Referring to our patient; intraoperatively aortic valve anatomy looked suitable for valve repair, so we performed plication of both the central and the free edge of the fused right and left aortic cusps. Aortic dimensions were within normal range which was not indicated for any further intervention.
Interestingly, the patient had concomitant mitral regurgitation due to perforation of the A3 segment of the anterior mitral valve. Presumably, due to the infective endocarditis he sustained. The mitral valve was repaired using a synthetic pericardial patch, followed by implantation of a 30mm Sorin Memo 4D annuloplasty ring. Nonetheless, mitral repair is now considered a standard approach to the mitral valve since the growing evidence of its effectiveness and durability.
Follow up Echocardiography showed competent repair in both valves.