[Significance of raphe in congenitally bicuspid aortic valve]

The decrease of rheumatic aortic regurgitation (AR) is observed due to the relative increase of non-rheumatic aortic valvular diseases since 1980. Among 240 patients who had undergone aortic valve replacement (AVR) including combined valvular diseases up to March 1989, the congenitally bicuspid aortic valve was responsible for AR and stenosis (AS) in 33 patients (13.8%) and were divided according to the presence of a raphe. In the raphe (+) group (n = 15), infective endocarditis (IE) (n = 5), prolapse of the aortic valve, mainly non-coronary cusp (n = 5), and thickening with contraction of cusp (n = 4) were the cause of AR. Calcification of the cusp was seen in 2 older (greater than 59 yrs) patients. In the raphe (-) group (n = 18), IE (n = 2), contraction of cusps (n = 2) in the relatively younger (less than 48 yrs) were the cause of AR. Rest of the patients exhibited severe AS due to the calcification of cusps except a case who showed IE with AR in the calcified cusp. Although not generally recognized, the bicuspid valve with a raphe, less tendency to deposit calcium, is an important cause of pure AR severe enough to warrant AVR. The bicuspid valve without raphe, as already recognized, prones to develop severe calcification and AS in later life.