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- W2912872599 abstract "We read the letter by Girdauskas et al about our article, recently published in The American Journal of Medicine,1Longobardo L. Jain R. Carerj S. et al.Bicuspid aortic valve: unlocking the morphogenetic puzzle.Am J Med. 2016; 129: 796-805Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar with true pleasure because they fully understood the core meaning of our manuscript. Indeed, they again emphasized the most important message of our article—that is, bicuspid aortic valve and the related aortopathy can hardly be considered a unique disease easily categorizable by classifications, but it is a complex entity, a mixture of different conditions, and a “continuous spectrum” of morphologies, as Sievers and Schmidtke described them in their initial paper.2Sievers H.H. Schmidtke C. A classification system for the bicuspid aortic valve from 304 surgical specimens.J Thorac Cardiovasc Surg. 2007; 133: 1226-1233Abstract Full Text Full Text PDF PubMed Scopus (764) Google Scholar However, the role of science—and medicine, in this case—is to try to portray the richness of nature with simple and easily understandable categories, sometimes unable to fully describe the variety of the reality, but efficient enough to allow a clear and immediate understanding of the topic discussed and an easy comparison between data. In this context, our suggestion of using a classification based on raphe position and cusp size should be read. Of course, a different classification, based on true prognostic elements and able to provide significant information about the management and outcomes of patients would be a great improvement—as correctly stated by Girdauskas et al—and should be advocated, but is currently lacking. Indeed, although some authors tried to find prognostic implications in the different aortic phenotypes3Sievers H.H. Stierle U. Mohamed S.A. et al.Toward individualized management of the ascending aorta in bicuspid aortic valve surgery: the role of valve phenotype in 1362 patients.J Thorac Cardiovasc Surg. 2014; 148: 2072-2080Abstract Full Text Full Text PDF PubMed Scopus (54) Google Scholar or according to serologic/rheological biomarkers,4Naito S. Hillebrand M. Bernhardt A.M. et al.The value of circulating biomarkers in bicuspid aortic valve-associated aortopathy.Thorac Cardiovasc Surg. 2016; ([e-pub ahead of print])PubMed Google Scholar there is no wide consensus about the findings, and one of the causes of it could be the difficulties in comparing data. Thus, starting to speak all “the same language”—an easy language that allows us to be clearly understood everywhere without differences—could be the first step to being able to put together the data available to obtain wider and globally accepted evidence about this complex disease and to improve the management and the outcomes of our patients. Interpreting Phenotypic Features of Bicuspid Aortic Valve Disease: From Simplification to Complexity to Simplicity?The American Journal of MedicineVol. 130Issue 7PreviewWe read with a great interest the review article published by Longobardo et al in The American Journal of Medicine.1 The authors highlighted the complex issue of heterogeneity in bicuspid aortic valve and difficulties while creating a classification system. On the basis of the best available evidence, the authors presented their perspective of integrating bicuspid valve morphotype with aortic phenotype, thereby trying to unlock the morphogenetic puzzle. From our point of view, this endeavor describes a common phenomenon of human thinking: breaking down the undefinable into fragments, splitting a continuous sequence into virtual components, and building up internal rules of action, while trying to adapt the complexity of nature. Full-Text PDF" @default.
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- W2912872599 date "2017-07-01" @default.
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