title: Aortic valve function after bicuspidization of the unicuspid aortic valve.
abstract: BACKGROUND
  Unicuspid aortic valve (UAV) anatomy leads to dysfunction of the valve in young individuals. We introduced a reconstructive technique of bicuspidizing the UAV. Initially we copied the typical asymmetry of a normal bicuspid aortic valve (BAV) (I), later we created a symmetric BAV (II). This study compared the hemodynamic function of the two designs of a bicuspidized UAV.
  
  
  METHODS
  Aortic valve function was studied at rest and during exercise in 28 patients after repair of UAV (group I, n = 8; group II, n = 20). There were no differences among the groups I and II with respect to gender, age, body size, or weight. All patients were in New York Heart Association class I. Six healthy adults served as control individuals. All patients were studied with transthoracic echocardiography between 4 and 65 months postoperatively. Systolic gradients were assessed by continuous wave Doppler while patients were at rest and exercising on a bicycle ergometer.
  
  
  RESULTS
  Aortic regurgitation was grade I or less in all patients. Resting gradients were significantly elevated in group I compared with group II and control individuals (group I, peak 33.8 ± 7.8 mm Hg; mean 19.1 ± 5.4 mm Hg; group II, peak 15.8 ± 5.4, mean 8.2 ± 2.8 mm Hg; control individuals, peak 6.0 ± 1.6, mean 3.2 ± 0.8 mm Hg; p < 0.001). At 100 W peak gradients were highest in group I (group I, 62.7 ± 16.7 mm Hg; group II, 28.1 ± 7.6 mm Hg; control individuals, 15.4 ± 4.6 mm Hg; p < 0.001).
  
  
  CONCLUSIONS
  Converting a UAV into a symmetric bicuspid design results in adequate valve competence. A symmetric repair design leads to improved systolic aortic valve function at rest and during exercise.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University of Saarland, Homburg/Saar, Germany. diana.aicher@uks.de
authors.forename: Diana
authors.initials: D
authors.lastname: Aicher
authors.forename: Moritz
authors.initials: M
authors.lastname: Bewarder
authors.forename: Michael
authors.initials: M
authors.lastname: Kindermann
authors.forename: Hashim
authors.initials: H
authors.lastname: Abdul-Khalique
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Schäfers
mesh_terms: D000328:Adult; D001021:Aortic Valve / Q000002:abnormalities* / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures