Repair-oriented bicuspid aortic valve classification according to commissural orientation. Commissural orientation optimal for repair is shown in the symmetrical type; the asymmetrical bicuspid aortic valve benefits from increasing its commissural angle; the very asymmetrical type should likely be best treated as a tricuspid aortic valve (see also Fig. 9). Note how the height of the fused commissure increases as the asymmetry increases and looks more like a tricuspid aortic valve. Note that the annulus tends to be more circular in symmetrical bicuspid aortic valve and becomes more elliptic with increasing bicuspid aortic valve asymmetry. From Pavel Zacek, MD, PhD, with permission.