commissural fusion
Pathological joining of valve leaflets at their commissures, typically seen in rheumatic valve disease, causing valve stenosis.
Full Definition
A pathological condition where the commissures (natural separation points) between heart valve leaflets become fused together, typically as a result of rheumatic heart disease, congenital abnormalities, or degenerative processes. This fusion restricts valve opening, leading to stenosis and impaired forward flow. In mitral valve disease, commissural fusion is often accompanied by chordal shortening and leaflet thickening, creating the characteristic 'fish-mouth' orifice. Commissural fusion can also affect the aortic valve, where bicuspid valve morphology may result from fusion of two cusps during development. Surgical treatment involves commissurotomy - carefully dividing the fused commissures to restore valve mobility and improve opening. The extent and nature of commissural fusion significantly influences the feasibility of valve repair versus replacement, with mobile leaflets and preserved subvalvular apparatus favoring repair options.
Usage
Usage note: Describe the extent and location of fusion to guide surgical decision-making.
In Context
- "Severe commissural fusion was noted at both mitral commissures, creating a stenotic fish-mouth orifice." — intraoperative findings
- "The degree of commissural fusion will determine whether valve repair or replacement is feasible." — surgical planning notes