DOCSLIB.ORG

Clinical Significance of the Bicuspid Aortic Valve

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Clinical Significance of the Bicuspid Aortic Valve Heart 2000;83:81–85 81 REVIEW Heart: first published as 10.1136/heart.83.1.81 on 1 January 2000. Downloaded from Clinical significance of the bicuspid aortic valve C Ward The association of bicuspid aortic valve with features of degenerative valve disease, the third aortic stenosis, aortic regurgitation, and infective major aetiological group: endocarditis has been known for almost 150 + Calcification increases with age and is years and with dissection of the aorta for 75 largely confined to the raphé (which does years.1 These complications are mentioned only not extend to the commissure) and base of briefly in cardiology textbooks3 and a standard the cusps, as it is in degenerative valves. It is work on medical insurance underwriting4 im- more diVuse in postinflammatory disease. plies that it is usually a benign lesion: when Calcification is conspicuous in virtually all diagnosed at routine medical examination and if adults with a severely stenosed bicuspid aor- the valve is functionally normal, insurance is tic valve but is uncommon in isolated aortic oVered at ordinary rates. The authors also state regurgitation.910 “If there is no stenosis by age 20 years (defined +Only in postinflammatory valves are cusp as a peak gradient of less than 40 mm Hg) and margins severely distorted and fused, result- only trivial insuYciency, there is an excellent ing in the valve often having a central tri- chance that significant haemodynamic change radiate orifice. will not develop before age 70.” However, on the + In virtually all cases, the aetiology of aortic basis of published reports by this age the major- stenosis can be determined by naked eye ity of patients will have died or developed serious examination of the valve.8 symptoms requiring surgical intervention. This + Where doubt exists, histological examina- review summarises the major studies that tion shows no valve tissue in the raphé of a provide information on the incidence, pathol- congenital bicuspid aortic valve, whereas ogy, and natural history of the bicuspid aortic postinflammatory valves show evidence of http://heart.bmj.com/ valve. Clinical diagnosis of this condition was previous valvitis.78These criteria have been unsatisfactory before the widespread use of consistently applied in subsequent patho- cross sectional echocardiography approximately logical studies, thus providing a high level of 15 years ago. Most of the information in this consistency to the identification of those paper therefore comes from large necropsy valves which are congenitally bicuspid. series and from reports on patients who have The orientation of the valve cusps, antero- undergone aortic valve replacement. It has to be posterior or left-right in approximately equal accepted that conclusions based on these numbers,57may have some bearing on compli- reports may be inaccurate, because of non- cation rates. The coronary arteries usually arise on September 29, 2021 by guest. Protected copyright. uniformity of diagnostic criteria and varying age in front of the anterior cusp5 which is the cusp range, source/selection of patients studied, and with the raphé. Stenosis usually develops in study objectives. bicuspid valves containing no redundant cusp A small percentage of malfunctioning con- tissue, and incompetence often in valves in genitally abnormal aortic valves are unicuspid which redundancy and prolapse are or unicommissural,5 but as most reports do not prominent.1 This had been confirmed by more distinguish this from bicuspid aortic valve the recent studies.9 Unicommissural aortic valves abbreviation “bicuspid aortic valve” will used are of two types, both of which are dome to include both types of valve unless stated shaped.10 One has no commissure, and the otherwise. other a single commissure which only partially divides the cusps. Most have some evidence of Anatomy and pathology two raphés, suggesting that they may have been Early pathology studies16 documented three tricuspid at an early stage of development. characteristics of bicuspid aortic valve: inequal- Many vascular abnormalities have been ity of cusp size, the presence of a central raphé associated with bicuspid aortic valve but only two are of common practical importance in North West Regional (ridge), usually in the centre of the larger of the Cardiac Centre, South two cusps, and smooth cusp margins even in adult cardiology. Manchester University diseased valves. Subsequently bicuspid aortic First, a bicuspid aortic valve occurs in NHS Trust, valve was diVerentiated from an initially tricus- 20–85% of cases of coarctation of the aorta.11 12 Southmoor Road, pid valve,7 two cusps of which had become The presence of an untreated, inadequately Manchester M23 9LT, fused as a result of rheumatic or other inflam- treated, or recurrent coarctation increases the UK C Ward matory processes. Other necropsy series have likelihood of developing aortic stenosis, aortic confirmed, elaborated, and refined these regurgitation, or dissection of the aorta (see Accepted 4 August 1999 characteristics,58 and have also described the below). Bicuspid aortic valve has also been 82 Ward reported in 27% of 52 cases of interrupted aor- is from this age group. In the light of these fig- tic arch,13 suggesting a common developmental ures the statement that “this is a very common Heart: first published as 10.1136/heart.83.1.81 on 1 January 2000. Downloaded from pathogenesis for congenital abnormalities of defect, being found once in every 100 to 200 the aorta and aortic valve. autopsies”7 is reasonable and provides a valid Second, 90% of patients with a normal (tri- basis for the generally accepted figure of an cuspid) aortic valve have right coronary artery overall incidence of 1–2%. dominance, that is the right coronary artery Because of case selection, some of the figures supplies the crux of the heart, and the left main quoted will have overestimated the incidence of stem averages 10 mm in length. With a complications but they are the only relevant bicuspid aortic valve, left dominance is more published data. They indicate that, at a common (between 29% and 56.8%14 15) and in conservative estimate, one third and possibly 90% of such cases the left main stem is less the majority of patients with bicuspid aortic than 5 mm in length.16 Failure to recognise valve will develop serious complications. these associations may result in inadequate myocardial preservation at the time of aortic Specific complications valve replacement and an increased risk of AORTIC STENOSIS perioperative myocardial infarction.16 Four reports define the clinical and pathologi- cal characteristics of bicuspid aortic valve Clinical diagnosis stenosis, three based on necropsy data5822and A clinical diagnosis of bicuspid aortic valve one on surgical specimens.23 There is broad based purely on the presence of an aortic ejec- agreement that approximately 50% of adults tion click, with or without an ejection systolic with severe aortic stenosis have a bicuspid aor- murmur, lacks predictive accuracy as it may be tic valve. Severely stenosed bicuspid aortic heard in tricuspid aortic valve stenosis, or in valves are very rigid because of fibrosis and aortic dilatation from any cause, and is absent heavy calcification, but are not narrowed.82023 when the valve cusps are rigid.17 18 The reliabil- Both calcification and fibrosis (and thus ity of diagnosis has been significantly improved deteriorating valve function) are age related.23 by the introduction of cross sectional and In a clinical series a third of initially asympto- Doppler echocardiography—a specificity of matic patients with bicuspid aortic valve 96%, a sensitivity of 78%, and a predictive deteriorated during a mean period of 10.9 accuracy 93% have been reported.19 Diagnosis years.24 Echocardiographic studies25 26 have is based on the demonstration of two cusps and shown that sclerosis of the valve begins in the two commissures during short axis visualisa- second decade, and calcification is increasingly tion. Supportive features include cusp redun- prominent from the fourth decade onwards; dancy and eccentric valve closure, and a single the average aortic valve gradient increases con- coaption line between the cusps during dias- currently by 18 mm Hg per decade. Stenosis tole. However, the usually bicuspid nature of a progressed more rapidly (27 mm Hg per http://heart.bmj.com/ valve may be obscured by severe fibrosis or cal- decade) if the cusps were asymmetrical in size cification and false negative results may be and in the anteroposterior location.26 In a sec- produced by a prominent raphé (which can ond report27 of 31 patients with an initially give the appearance of a third coaption line); a functionally normal valve (mean gradient < 25 false positive diagnosis may occur when one mm Hg), four had an undefined increase in coaption line of a tricuspid valve is unclear. gradient and three required aortic valve surgery during a median follow up time of 21 months. The incidence of bicuspid aortic valve High serum low density lipoprotein choles- on September 29, 2021 by guest. Protected copyright. and complications terol, high serum lipoprotein (a), and smoking Four necropsy series56820 provide the only are independent risk factors for aortic stenosis basis we have for estimating the incidence of and presumably contribute to the age related bicuspid aortic valve in the adult population, as deterioration.28 diagnosis by auscultation is insuYciently accu- Bicuspid aortic valve is the commonest aeti- rate and no relevant echocardiographic study ology of aortic stenosis between the ages of 60 has been published. The incidence of normally and 75 years (59% of cases); it was also the functioning bicuspid aortic valves is 0.6% to cause in 40% of those aged under 60 years and 0.9%.5621 This is probably the minority of 32% of those aged more than 75 years.8 The bicuspid aortic valves, as only 15–28%56 are relation between age and bicuspid aortic valve reported as normal in necropsy series.
Load more

Recommended publications
  • Having an Echocardiogram to Screen for a Bicuspid Aortic Valve
    Having an echocardiogram to screen for a bicuspid aortic valve UHB is a no smoking Trust To see all of our current patient information leaflets please visit www.uhb.nhs.uk/patient-information-leaflets.htm What is a bicuspid aortic valve? The aortic valve sits between the main chamber of the heart (the left ventricle) and the aorta. Its function is to ensure that blood flows correctly forward from the left ventricle into the aorta. Normally it has three thin leaflets which open as the heart contracts and then close to prevent back-flow of blood towards the ventricle. Aortic valve Tricuspid aortic valve (normal) Bicuspid aortic valve (abnormal) Some people may be born with an aortic valve made up of only 2 leaflets. The valve is then called bicuspid. This may cause problems with the functioning of the valve in that it may be more prone to gradually becoming narrowed or leaky. Sometimes a bicuspid valve may be associated with widening of the portion of the aorta that is connected to it. Widening of the aorta may occur in some relatives even if they have an aortic valve with 3 leaflets. If this widening is significant it is known as an aortic aneurysm. Is a bicuspid valve a common problem? Studies have suggested that this is not an uncommon valve problem and may occur in up to 1 in 200 people. 2 | PI18_1443_03 Having an echocardiogram to screen for a bicuspid aortic valve Recently there has been evidence that this condition may be genetic and thus have a tendency to run in a family.
    [Show full text]
  • Echo in Asymptomatic Mitral and Aortic Regurgitation
    2017 ASE Florida | Orlando, FL October 9, 2017 | 10:40 – 11:00 PM | 20 min | Grand Harbor Ballroom South Echo in Asymptomatic Mitral and Aortic Regurgitation Muhamed Sarić MD, PhD, MPA Director of Noninvasive Cardiology | Echo Lab Associate Professor of Medicine Disclosures Speakers Bureau (Philips, Medtronic) Advisory Board (Siemens) Regurgitation Axioms ▪Typically, regurgitation is NOT symptomatic unless severe ▪The opposite is not true: Severe regurgitation may be asymptomatic ▪ Chronic regurgitation leads to chamber dilatation on either side of the regurgitant valve Regurgitation Discovery ▪ Regurgitation as a anatomic entity was recognized in the 17th century ▪ Regurgitation was first clinically diagnosed by auscultation in the 19th century, well before the advent of echocardiography First Use of Regurgitation Term in English 1683 W. Charleton Three Anat. Lect. i. 18 Those [valves] that are placed in the inlet and outlet of the left Ventricle, to obviate the regurgitation of the bloud into the arteria venosa, and out of the aorta into the left Ventricle. Walter Charleton (1619 – 1707) English Physician Heart Murmur OXFORD ENGLISH DICTIONARY DEFINITION ▪ Any of various auscultatory sounds ▪ Adventitious sounds of cardiac or vascular origin [that is, separate from standard heart sounds: S1, S2, S3, S4] ▪ Sometimes of no significance ▪ But sometimes caused by valvular lesions of the heart or other diseases of the Στῆθος : Stēthos = chest circulatory system René Laënnec Stethoscope (1781 – 1826) (‘Chest examiner’) French Physician Hollow wooden cylinder Inventor of stethoscope in 1816 Laënnec Performing Auscultation Painted by Robert Alan Thom (1915 – 1979), American illustrator Commissioned by Parke, Davis & Co. 1816 1832 René Laënnec, James Hope French physician British physician Invents MONAURAL stethoscope separates MS from MR murmur 1852 1862 George Cammann Austin Flint Sr.
    [Show full text]
  • Congenital Mitral Incompetence and Coarctation Ofaorta
    Thorax: first published as 10.1136/thx.27.6.729 on 1 November 1972. Downloaded from Thorax (1972), 27, 729. Congenital mitral incompetence and coarctation of aorta Report of two cases treated surgically' ABDEL K. TERZAKI2, ROBERT D. LEACHMAN3, M. KHALIL ALI, GRADY L. HALLMAN, and DENTON A. COOLEY Department of Medicine and the Cora and Webb Mading Department of Surgery, Baylor University College of Medicine, and the Cardiology and Surgical Sections of the Texas Heart Institute of St. Luke's Episcopal and Texas Children's Hospitals, Houston, Texas, U.S.A. Two patients with congenital mitral incompetence and coarctation of the aorta are presented. One patient had associated patent ductus arteriosus, bicuspid aortic valve, and endocardial fibro- elastosis. The diagnosis in the two patients presented is well established by clinical, laboratory, and surgical findings and also by necropsy examination in one case. It is proposed that the rarity of reported cases in the literature may have resulted from the frequent diagnosis of left ventricular failure in infancy secondary to coarctation, leading to the assumption that a mitral insufficiency murmur, when present, is due to functional regurgitation. Likewise, the murmur may be mistakenly thought to originate from a ventricular septal defect. The diagnosis of coarctation of the aorta presented no problem in either patient, while detection of the mitral incompetence was difficult. Coarctation of the aorta complicated by copyright. pulmonary hypertension in the absence of intracardiac shunt should draw attention to the possi- bility of associated mitral incompetence. Congestive heart failure, especially after correction of coarctation, was also an indication of possible associated mitral insufficiency.
    [Show full text]
  • Prevalence of Migraine Headaches in Patients with Congenital Heart Disease
    Prevalence of Migraine Headaches in Patients With Congenital Heart Disease Tam Truong, MD, Leo Slavin, MD, Ramin Kashani, BA, James Higgins, MD, Aarti Puri, BS, Malika Chowdhry, BS, Philip Cheung, BS, Adam Tanious, BA, John S. Child, MD, FAHA, Joseph K. Perloff, MD, and Jonathan M. Tobis, MD* The prevalence of migraine headaches (MH) is 12% in the general population and increases to 40% in patients with patent foramen ovale. This study evaluated the prevalence of MH in patients with congenital heart disease (CHD). Of 466 patients contacted from the UCLA Adult Congenital Heart Disease Center, 395 (85%) completed a questionnaire to determine the prevalence of MH. Patients were stratified by diagnosis of right-to-left, left-to-right, or no shunt. A group of 252 sex-matched patients with acquired cardiovascular disease served as controls. The prevalence of MH was 45% in adults with CHD compared to 11% in the controls (p <0.001). Of the 179 patients with MH, 143 (80%) had migraines with aura and 36 (20%) had migraines without aura versus 36% and 64% observed in the controls (p <0.001). The frequency of MH was 52% in the right-to-left shunt group, 44% in the left-to-right, and 38% in the no ,NS). In patients with a right-to-left shunt who underwent surgical repair ؍ shunt group (p 47% had complete resolution of MH, whereas 76% experienced >50% reduction in headache days per month. In conclusion, the prevalence of MH in all groups of adults with CHD is 3 to 4 times more than a sex-matched control population, with increasing prevalence of MH in patients with no shunt, left-to-right, and right-to-left shunt.
    [Show full text]
  • How Not to Miss a Bicuspid Aortic Valve in the Echocardiography Laboratory
    ECHO ROUNDS Section Editor: E. Kenneth Kerut, M.D. How Not to Miss a Bicuspid Aortic Valve in the Echocardiography Laboratory Salvatore J. Tirrito, M.D.∗ and Edmund Kenneth Kerut, M.D.∗,† ∗Section of Cardiology, Tulane University Health Sciences Center, New Orleans, Louisiana †Heart Clinic of Louisiana, Marrero, Louisiana bicuspid aortic valve, echocardiography, congenital heart disease Diagnosis of bicuspid aortic valve (BAV) Address for correspondence and reprint requests: in the busy echocardiography laboratory is Salvatore J. Tirrito, M.D., Tulane University Health Sci- important, as it is a relatively common cardiac ences Center, Section of Cardiology SL-48, 1430 Tulane Av- enue, New Orleans, LA 71112. Fax: 504 529-9649; E-mail: congenital defect (up to 3% of the popula- 1 [email protected] tion), and requires a recommendation for Figure 1. M-mode and two-dimensional (2D) diastolic frame in the parasternal long-axis view of a bicuspid aortic valve with eccentric closure (arrows). Although not diagnostic, an eccentric line of closure should prompt one to evaluate the aortic valve closely for BAV. LA = left atrium. (Modified with permission from: Kerut EK, McIlwain, Plotnick: Handbook of Echo-Doppler Interpretation 2nd Ed, Blackwell Publishing, Elmsford, New York, 2004, p. 84) Vol. 22, No. 1, 2005 ECHOCARDIOGRAPHY: A Jrnl. of CV Ultrasound & Allied Tech. 53 TIRRITO AND KERUT Figure 2. Diastolic (left panel) and systolic (right panel) two-dimensional (2D) short-axis image of a BAV. In diastole the raphe may appear as a commissure (arrow), appearing to be a normal tri-leaflet valve. However,the systolic frame has a typical “fish-mouth” appearance.
    [Show full text]
  • Bicuspid Aortic Valve
    © 2012 The Children’s Heart Clinic NOTES: Children’s Heart Clinic, P.A., 2530 Chicago Avenue S, Ste 500, Minneapolis, MN 55404 West Metro: 612-813-8800 * East Metro: 651-220-8800 * Toll Free: 1-800-938-0301 * Fax: 612-813-8825 Children’s Minnesota, 2525 Chicago Avenue S, Minneapolis, MN 55404 West Metro: 612-813-6000 * East Metro: 651-220-6000 © 2012 The Children’s Heart Clinic Reviewed March 2019 Bicuspid Aortic Valve A bicuspid aortic valve is form of congenital heart disease where the aortic valve only has two leaflets, instead of three. This typically results from fusion (joining) of two cusps of the valve along their coaptation point. A bicuspid aortic valve occurs in 1-2% of the population. It can occur alone or be associated with other left-sided heart lesions, such as mitral valve abnormalities (see mitral stenosis), or coarctation of the aorta. Symptoms and presentation can vary for patients with bicuspid aortic valve depending upon the degree of stenosis (narrowing) or regurgitation (leaking) of the valve. Physical Exam/Symptoms: Most patients with bicuspid aortic valve have no symptoms (asymptomatic), unless there is associated aortic stenosis (AS) (narrowing) or regurgitation (leaking) (AR) Most children are asymptomatic with mild to moderate AS. Fatigue, chest pain with exertion, or syncope (fainting) may occur in severe AS. In critical AS, neonates develop poor perfusion, pulmonary edema (fluid retention in the lungs) within days or weeks after birth as the ductus arteriosus (see Patent Ductus Arteriosus) closes. Clinical picture may resemble that of sepsis (severe infection). Murmur of AS: Harsh, grade II/VI systolic murmur heard best at the second left intercostal space, with transmission to the head and neck.
    [Show full text]
  • Dextrocardia and Hiatal Hernia in a Patient with Turner Syndrome
    IJMS Vol 30, No 2, June 2005 Case Report Dextrocardia and Hiatal Hernia in a Patient with Turner Syndrome R. Vakili, M. Horri1 Abstract Turner syndrome is a sex-chromosome disorder occurring in one out of 2500 female births and characterized by growth re- tardation, gonadal dysgenesis and cardiovascular anomalies. The 45, XO karyotype is the most frequent type of this disease. Herein, we report on a 6-year-old girl with Turner syndrome and 45, XO karyotype presenting with short stature. She had dextrocardia and hiatal hernia. To the best of our knowledge, the association of Turner syndrome, dextrocardia and hiatal hernia is quite rare. Iran J Med Sci 2005; 30(2): 97-99. Keywords ● Turner syndrome ● dextrocardia ● hiatal hernia Introduction urner syndrome (TS) is the most common chromoso- mal abnormalities resulting in the loss of all or a part of T an X chromosome. The rate of the syndrome reported variably between 1/2000 and 1/5000 live born phenotypically female births.1 This syndrome is characterized by short stature, gonadal failure, low posterior hairline, thoracic and cardiovas- cular malformations.2 The occurrence of cardiac malformations in TS has long been recognized.3 Coarctation of the aorta and bicuspid aortic valves are the most common heart defects in TS.4 Other cardiovascular malformations such as aortic steno- sis and regurgitation, hypoplastic left heart have also been re- ported with less frequency.5 Case Presentation A 6-year-old girl referred to the Pediatrics Endocrinology & Me- tabolism Clinic of Mashhad University of Medical Sciences, Mashhad, Iran, for evaluation of growth retardation.
    [Show full text]
  • Valvular Heart Disease CLASS (STRENGTH) of RECOMMENDATION LEVEL (QUALITY) of EVIDENCE‡ CLASS 1 (STRONG) Benefit >>> Risk LEVEL A
    Clinical Update ADAPTED FROM: 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease CLASS (STRENGTH) OF RECOMMENDATION LEVEL (QUALITY) OF EVIDENCE‡ CLASS 1 (STRONG) Benefit >>> Risk LEVEL A Suggested phrases for writing recommendations: • High-quality evidence‡ from more than 1 RCT • Is recommended • Meta-analyses of high-quality RCTs • Is indicated/useful/effective/beneficial • One or more RCTs corroborated by high-quality registry studies • Should be performed/administered/other Table 1. • Comparative-Effectiveness Phrases†: LEVEL B-R (Randomized) − Treatment/strategy A is recommended/indicated in preference to • Moderate-quality evidence‡ from 1 or more RCTs treatment B ACC/AHA • Meta-analyses of moderate-quality RCTs − Treatment A should be chosen over treatment B LEVEL B-NR (Nonrandomized) Applying Class of CLASS 2a (MODERATE) Benefit >> Risk • Moderate-quality evidence‡ from 1 or more well-designed, well- Suggested phrases for writing recommendations: executed nonrandomized studies, observational studies, or registry Recommendation Is reasonable • studies • Can be useful/effective/beneficial • Meta-analyses of such studies and Level of • Comparative-Effectiveness Phrases†: − Treatment/strategy A is probably recommended/indicated in preference to LEVEL C-LD (Limited Data) treatment B Evidence to − It is reasonable to choose treatment A over treatment B • Randomized or nonrandomized observational or registry studies with limitations of design or execution Clinical Strategies, CLASS 2b (Weak) Benefit ≥ Risk • Meta-analyses of such studies • Physiological or mechanistic studies in human subjects Suggested phrases for writing recommendations: Interventions, • May/might be reasonable LEVEL C-EO (Expert Opinion) • May/might be considered Treatments, or • Usefulness/effectiveness is unknown/unclear/uncertain or not well-established • Consensus of expert opinion based on clinical experience.
    [Show full text]
  • A Possible Increase in the Incidence of Congenital Heart Defects Among the Offspring of Affected Parents
    CORE Metadata, citation and similar papers at core.ac.uk Provided by Elsevier - Publisher Connector 376 lACC Vol. 6, No.2 August 1985:376-82 PEDIATRIC CARDIOLOGY A Possible Increase in the Incidence of Congenital Heart Defects Among the Offspring of Affected Parents VERA ROSE, BSc, MB, BS, FRCP(C) , REYNOLD JOHN MORLEY GOLD, MB, BCHIR, PHD, FCCMG, GAIL LINDSAY, RN, MSN, BScN, MARYLIN ALLEN, RN, PHN Toronto, Ontario, Canada The incidence of congenital heart disease in the children dence than that reported in most comparable studies. of219 probands was determined. Each of these probands The difference is highly significant statistically and there• had one of four selected defects: atrial septal defect, fore is likely to be genuine. The cause of the high re• coarctation of the aorta, aortic valve stenosis or complex currence is probably environmental. dextrocardia. Of their children, 8.8% had substantial (J Am Coli CardioI1985;6:376-82) congenital cardiac defects. This is a much higher inci- The successful medical and surgical treatment of congenital first degree relatives of those affected with it therefore offers heart disease has increased the importance of its early di• evidence as to whether the disease is polygenic. agnosis and this in tum has contributed to the growing Nora et al. (4) were the first to undertake family studies interest in the risk of cardiac defects in the offspring of to determine whether the actual incidence of congenital heart affected parents. Although a few cases of congenital heart disease in first degree relatives corresponds to that predicted disease are known to be caused by environmental agents, by this model.
    [Show full text]
  • Pathology of the Aortic Valve: Aortic Valve Stenosis/Aortic Regurgitation
    Current Cardiology Reports (2019) 21: 81 https://doi.org/10.1007/s11886-019-1162-4 STRUCTURAL HEART DISEASE (RJ SIEGEL AND NC WUNDERLICH, SECTION EDITORS) Pathology of the Aortic Valve: Aortic Valve Stenosis/Aortic Regurgitation Gregory A. Fishbein1 & Michael C. Fishbein1 Published online: 5 July 2019 # Springer Science+Business Media, LLC, part of Springer Nature 2019 Abstract Purpose of Review This discussion is intended to review the anatomy and pathology of the aortic valve and aortic root region, and to provide a basis for the understanding of and treatment of the important life-threatening diseases that affect the aortic valve. Recent Findings The most exciting recent finding is that less invasive methods are being developed to treat diseases of the aortic valve. There are no medical cures for aortic valve diseases. Until recently, open-heart surgery was the only effective method of treatment. Now percutaneous approaches to implant bioprosthetic valves into failed native or previously implanted bioprosthetic valves are being developed and utilized. A genetic basis for many of the diseases that affect the aortic valve is being discovered that also should lead to innovative approaches to perhaps prevent these disease. Sequencing of ribosomal RNA is assisting in identifying organisms causing endocarditis, leading to more effective antimicrobial therapy. Summary There is exciting, expanding, therapeutic innovation in the treatment of aortic valve disease. Keywords Aortic stenosis . Aortic regurgitation . Calcific degeneration . Bicuspid aortic valve . Rheumatic valve disease . Endocarditis . Transcatheter aortic valve implantation (TAVI) . Aortic valve replacement . Myxomatous degeneration . Endocarditis . Non-bacterial thrombotic endocarditis (NBME) Introduction aortic valve disease; however, effective methods of valve repair and replacement exist and percutaneous approaches Hemodynamically significant aortic valve disease, in one to treat aortic valve disease are being utilized with increasing form or another, is a relatively common disorder.
    [Show full text]
  • Evaluation of the Mitral and Aortic Valves with Cardiac CT Angiography
    PICTORIAL ESSAY Evaluation of the Mitral and Aortic Valves With Cardiac CT Angiography Samir V. Chheda, BS, Monvadi B. Srichai, MD, Robert Donnino, MD, Danny C. Kim, MD, Ruth P. Lim, MBBS, and Jill E. Jacobs, MD annulus shares structural continuity with the aortic annulus Abstract: Cardiac computed tomographic angiography (CTA) through 3 fibrous trigones (Fig. 1). Owing to this anatomic using multidetector computed tomographic scanners has proven to connection, diseases of the mitral annulus can affect the be a reliable technique to image the coronary vessels. CTA also aortic annulus and vice versa.1 Unless the mitral annulus is provides excellent visualization of the mitral and aortic valves, and calcified, its border is difficult to identify on CTA.2 yields useful information regarding valve anatomy and function. The mitral valve is the only cardiac valve with 2 Accordingly, an assessment of the valves should be performed whenever possible during CTA interpretation. In this paper, we leaflets. The anterior leaflet is semicircular in shape, highlight the imaging features of common functional and struc- whereas the posterior leaflet is rectangular. Owing to its tural left-sided valvular disorders that can be seen on CTA position within the left ventricle, the anterior leaflet also examinations. functions as a separation between the inflow and outflow tracts of the left ventricle. Key Words: computed tomography, cardiac, valves, angiography The 2 commissures are clefts that divide the 2 leaflets (J Thorac Imaging 2010;25:76–85) from each other. In some pathologic states, however, the commissural spaces may become obliterated and the leaflets appear fused.
    [Show full text]
  • CHD Associated with Syndromic Diagnoses: Peri-Operative Risk Factors and Early Outcomes
    CORE Metadata, citation and similar papers at core.ac.uk Provided by IUPUIScholarWorks HHS Public Access Author manuscript Author ManuscriptAuthor Manuscript Author Cardiol Manuscript Author Young. Author manuscript; Manuscript Author available in PMC 2016 November 28. Published in final edited form as: Cardiol Young. 2016 January ; 26(1): 30–52. doi:10.1017/S1047951115001389. CHD associated with syndromic diagnoses: peri-operative risk factors and early outcomes Benjamin J. Landis, David S. Cooper, and Robert B. Hinton Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America Abstract CHD is frequently associated with a genetic syndrome. These syndromes often present specific cardiovascular and non-cardiovascular co-morbidities that confer significant peri-operative risks affecting multiple organ systems. Although surgical outcomes have improved over time, these co- morbidities continue to contribute substantially to poor peri-operative mortality and morbidity outcomes. Peri-operative morbidity may have long-standing ramifications on neurodevelopment and overall health. Recognising the cardiovascular and non-cardiovascular risks associated with specific syndromic diagnoses will facilitate expectant management, early detection of clinical problems, and improved outcomes – for example, the development of syndrome-based protocols for peri-operative evaluation and prophylactic actions may improve outcomes for the more frequently encountered syndromes such as 22q11 deletion syndrome. Keywords
    [Show full text]