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The bicornuate (heart shaped) uterus represents incomplete fusion of the two Mullerian ducts during embryonic development within the mother’s uterus. The central depression at the top of the (bicornuate) uterine cavity (green) is not due to the (abnormal) presence of poorly vascularized tissue (as it is with a septate uterus) and therefore these (bicornuate) uterine cavities often have normal reproductive potential.
If surgical repair of the bicornuate uterus is deemed necessary (as with a history of otherwise unexplained recurrent pregnancy loss) it is important to realize that this repair cannot be accomplished hysteroscopically. If the (green) central defect (of a bicornuate uterus) is transected hysteroscopically then perforation through the top of the uterus is very likely (since the outer uterine wall is depressed or heart shaped). Surgical repair requires (through and through) opening of the uterine wall with subsequent reconstruction, which can only be accomplished with a laparotomy (large abdominal) skin incision.
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