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J Thorac Cardiovasc Surg. 2013 Aug;146(2):269-74. doi: 10.1016/j.jtcvs.2012.06.053. Epub 2012 Jul 31.

Cusp height in aortic valves.

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Department of Thoracic and Cardiovascular Surgery, University Hospitals of Saarland, Homburg/Saar, Germany.



Successful aortic valve repair must normalize cusp and root dimensions. Limited information is available on the normal dimensions of human cusps, in particular the cusp height.


The cusp height was measured intraoperatively in 621 patients during aortic valve repair procedures. A tricuspid anatomy was present in 329 patients and bicuspid in 286 patients. In addition, patient age, gender, height, weight, preoperative degree of aortic regurgitation, and aortic dimensions were recorded. The data were analyzed for possible interrelation between the cusp height and clinical variables.


In the bicuspid valves, the geometric height of the nonfused cusp ranged from 15 to 30 mm (mean, 23.8 ± 2.0). Significant correlations were found between the cusp height and all clinical variables. In the tricuspid valves, the height of the noncoronary cusp ranged from 14 to 28 mm (mean, 20.7 ± 2.2). The height of the left coronary cusp varied from 12 to 25 mm (mean, 20.0 ± 2.1) and that of the right coronary cusp from 12 to 25 mm (mean, 20.0 ± 2.1). The noncoronary cusp was significantly greater than the left and the right coronary cusp (P = .000). No difference was found between the left and right cusps (P = .513). Significant correlations between the geometric height and clinical parameters were found for most clinical variables, excluding the degree of aortic regurgitation.


We found the cusp height was larger than previously published. It shows marked variability and correlates with the clinical variables. These data might serve as the basis for decision making in aortic valve repair.


18; 35; BAV; TAV; TEE; bicuspid aortic valve; transesophageal echocardiography; tricuspid aortic valve

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