Tricuspidization technique with reimplantation for a bicuspid aortic valve: a case report

Bicuspid aortic valve (BAV) is the most frequent congenital cardiac anomaly. We report a successful case in which the tricuspidization technique with valve-sparing aortic root replacement was used for BAV with severe aortic regurgitation.

A 22-year-old man was admitted for progressively worsening aortic regurgitation due to a congenital BAV. Preoperative examination revealed annuloaortic ectasia and left ventricular dilatation with worsening ejection fraction. The right and left coronary cusps of the aortic valve were fused with severe prolapse. During surgery, as there was no obvious calcification or degeneration of each coronary cusp and the commissural orientation was nearly 120°, we judged that tricuspid reconstruction was preferable. Neo-left and right commissure reconstruction by raphe suspension and free margin resuspension of the non-coronary cusp were performed with valve-sparing aortic root replacement (reimplantation technique). Postoperatively, the coaptation height of each coronary cusp was remarkably increased, and aortic regurgitation and left ventricular function improved. The patient was discharged 12 days postoperatively without any complications.

The tricuspidization technique with valve-sparing aortic root replacement was a valuable strategy for repairing the bicuspid valve (type I) with severe aortic valve regurgitation. Although we believe that our tricuspidization technique has the potential for good durability, further experience is warranted to confirm the safety and efficacy of this technique.