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©2013 UpToDate ® Print Email A second bivalve of this ovary leads to further release of capsular pressure allowing increased arterial perfusion and thus a less dusky appearance This ovarian bivalve procedure demonstrates that the ovarian tissue, despite an initially non-viable appearance, can retain perfused and viable tissues. Bivalving may serve as a valuable intra-operative triage tool to assess viability and avoid unnecessary extirpation of viable ovaries. Reproduced with permission from: Pediatric and Adolescent Gynecology, 6th ed, Emans SJ, Laufer MR, Goldstein DP (Eds), Lippincott Williams & Wilkins, Philadelphia 2012. Copyright © 2012 Lippincott Williams & Wilkins. file://www.lww.com