Forme fruste unicuspid aortic valves

Le résumé fourni par la source

Over the last decade, a seismic shift in aortic valve morphologies has occurred, with the seminal work of de Kerchove et al.1 We now understand aortic valves as a spectrum of valve phenotypes, which can range from unicuspid to quadricuspid aortic valves, and with tricuspid aortic valves (TAVs) being the normal valve phenotype. Yet, even in seemingly normal TAVs, we see fine variations towards bicuspid aortic valves (BAVs) with the occasional lower commissure or a subtle raphe (forme fruste BAV), which may go unnoticed by the inexperienced clinician.2 Especially for BAVs, we now categorize them based on commissural orientation, which can range from 180° to 120°.3 With this, there are variations of the height of the raphe and the length of cusp fusion. Unicuspid aortic valves (UAVs) are simply subcategorized into uni- or acommissural phenotypes.4 Similar to BAVs, UAVs may have subtle variations of their raphe and raphe height as well. Herein, we present for the first time a forme fruste UAV, which can easily go unnoticed and be mistaken for a BAV. Yet, the anterior commissure in reality is a raphe not easily diagnosed on echocardiography. Hence, there is one fully developed raphe with a low raphe height and a long line of fusion (Figure 1, blue arrows). However, there is also another raphe, which has a high insertion with a very short line of fusion and could easily be mistaken for a genuine commissure (Figure 1, green arrows). The difference could only definitively be appreciated upon surgical visualization, and these variations impact the surgical repair approach. Supplementary data are not available at European Heart Journal online. All authors declare no disclosure of interest for this contribution. No data were generated or analysed for this manuscript.

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