The anatomopathology of bicuspid aortic valve

The bicuspid aortic valve is a common congenital heart disease characterised by inequality of cusp size, a central raphe, and smooth cusp margins even in diseased valves. It may progress and become calcified, leading to varying degrees of aortic valve disorders, such as stenosis, regurgitation, or combined, which may eventually necessitate surgical intervention. The bicuspid aortic valve is not a disorder confined to the aortic valve, but a spectrum involving the aortic valve, aortic annulus, aortic root, ascending aorta, and the left ventricular outflow tract. Different types of bicuspid aortic valves may present with distinct aetiologies and morphologies. The anatomopathological features of the bicuspid aortic valve have not been sufficiently elucidated. Differences in the anatomy of the bicuspid aortic valve could reflect different pathogeneses and different needs for different therapeutic approaches. Debates still remain in terms of timing of surgery and surgical indications of this disorder. The aim of the present article is to make a review of the anatomy and the management strategies of the bicuspid aortic valve in order to draw inferences about the clinical implications.