Tricuspidization of a unicuspid aortic valve in an adolescent using selective single-cusp replacement

Unicuspid aortic valves in adolescents frequently present with combined stenosis and regurgitation but often retain sufficient native tissue to allow reconstructive repair. We present a tricuspidization technique based on selective replacement of a dysplastic cusp with autologous pericardium and creation of two neocommissures to restore symmetric leaflet closure. The operation converts a functionally unicuspid valve into a tricuspid configuration while preserving native leaflet tissue. In the presented case, the repair resulted in competent valve function with low transvalvular gradient at follow-up. This technique may serve as a growth-preserving strategy to postpone definitive valve replacement in selected paediatric patients.