TAVI in Bicuspid Aortic Valves ‘Made Easy’

Insights and valuable tips from the ‘Right Cusp Rules’ for Transcatheter Aortic Valve Implantation (TAVI) in Bicuspid Aortic Valve (BAV) Stenosis Bicuspid aortic valve is the most common congenital cardiac anomaly with an estimated incidence of 0.4–2.25% in the general population,1 comprising a spectrum of deformed aortic valves presenting on gross examination with two functional cusps forming a valve mechanism with less than three zones of parallel apposition between cusps.2 The ‘purely’ BAV (Non-Raphe-type or BAV type 0) (Figure 1A) is composed of two cusps, morphologically, and functionally. However, the most frequent form of congenital BAV consists of three cusps with a raphe replacing one, or two, of the commissures (Raphe, or BAV, types I and II—defined by the presence of one or two raphes, respectively).2 ... Raphe-type BAV results from coronary cusp fusion (Left-Right) (Figure 1B) or mixed cusp fusion (non-right (Figure 1C), or rarely non-left).2 Non-raphe type BAV arises from degenerative coronary cusp fusion (antero-posterior) or mixed cusp fusion (lateral).