Bicuspid Aortic Valve Tissue Composition: Three-Layered Structure

The bicuspid aortic valve (BAV) consists of dense irregular connective tissue rich in collagen and elastin fibers.

Leaflet Layers (from blood-facing to aortic side)

  1. Endothelial layer (ventricularis): Single squamous cells; non-thrombogenic surface.
  2. Connective tissue core (fibrosa/spongiosa): Collagen (tensile strength), elastin (recoil), proteoglycans (hydration).
  3. Smooth muscle cell layer (aortic side): Contributes to valve tone and remodeling.

This trilaminar architecture provides durability for ~3 billion lifetime cycles. BAVs have abnormal collagen/elastin organization, predisposing to stenosis, regurgitation, and aortopathy.

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