Fig. 1

Intraoperative situs of aortic valve repair in bicuspid aortic valve (BAV) disease. The surgical repair consists of reduction of the aortic valve anulus using suture annuloplasty and correction of the prolapse of the fused cup. The aim is the recreation of the optimal aortic root geometry. This includes reduction of the basal ring diameter to less than 25 mm and restoration of effective cusp height (coaptation length) above 8 mm. a and b Correction of cusp prolapse by means of plication sutures (arrows). c Surgery results in a symmetric configuration of the bicuspid aortic valve (arrow heads) with a commissural angle of 180°, resembling a Sievers type 0 valve. In this patient, additional replacement of the aortic root with Dacron prosthesis for aneurysm has been performed