Bicuspid aortic valve annulus: assessment of geometry and size changes during the cardiac cycle as measured with a standardized method to define the annular plane

Abstract Purpose Bicuspid aortic valve (BAV) is a complex malformation affecting not merely the aortic valve. However, little is known regarding the dynamic physiology of the aortic annulus in these patients and whether it is similar to tricuspid aortic valves (TAV). Determining the BAV annular plane is more challenging than for TAV. Our aim was to present a standardized methodology to determine BAV annulus and investigate its changes in shape and dimensions during the cardiac cycle. Methods BAV patients were prospectively included and underwent an ECG-gated cardiac CTA. The annulus plane was manually identified on reconstructions at 5% intervals of the cardiac cycle with a new standardized method for different BAV types. Based on semi-automatically defined contours, maximum and minimum diameter, area, area-derived diameter, perimeter, asymmetry ratio (AR), and relative area were calculated. Differences of dynamic annular parameters were assessed also per BAV type. Results Of the 55 patients included (38.4 ± 13.3 years; 58% males), 38 had BAV Sievers type 1, 10 type 0, and 7 type 2. The minimum diameter, perimeter, area, and area-derived diameter were significantly higher in systole than in diastole with a relative change of 13.7%, 4.8%, 13.7%, and 7.2% respectively (all p < 0.001). The AR was ≥ 1.1 in all phases, indicating an elliptic shape, with more pronounced flattening in diastole (p < 0.001). Different BAV types showed comparable dynamic changes. Conclusions BAV annulus undergo significant changes in shape during the cardiac cycle with a wider area in systole and a more elliptic conformation in diastole regardless of valve type. Key Points • A refined method for the identification of the annulus plane on CT scans of patients with bicuspid aortic valves, tailored for the specific anatomy of each valve type, is proposed. • The annulus of patients with bicuspid aortic valves undergoes significant changes during the cardiac cycle with a wider area and more circular shape in systole regardless of valve type. • As compared to previously published data, the bicuspid aortic valve annulus has physiological dynamics similar to that encountered in tricuspid valves but with overall larger dimensions.

Download Full-text

Aortic valve-sparing root replacement in patients with bicuspid aortic valve: long-term outcome with the David I procedure over 20 years

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa083 ◽

2020 ◽

Vol 58 (1) ◽

pp. 86-93 ◽

Cited By ~ 3

Author(s):

Erik Beckmann ◽

Andreas Martens ◽

Heike Krüger ◽

Wilhelm Korte ◽

Tim Kaufeld ◽

...

Keyword(s):

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Aortic Valves ◽

Term Outcome ◽

Long Term Outcome ◽

Initial Surgery ◽

Bicuspid Aortic Valves ◽

Valve Sparing

Abstract OBJECTIVES Aortic valve-sparing root replacement is an excellent treatment option for patients with intact tricuspid aortic valves. However, the durability in patients with bicuspid aortic valves is still a matter of debate. The aim of this study was to analyse the short- and long-term outcomes in patients with bicuspid aortic valves. METHODS Between July 1993 and October 2015, a total of 582 patients underwent the David I procedure, 50 of whom had a bicuspid aortic valve. In these patients, the mean age was 46 ± 13 years, and 80% (n = 40) were men. Follow-up was complete for 100% of patients and comprised a total of 552 patient-years with a mean follow-up time of 11 ± 5.2 years. RESULTS In addition to the David procedure, cusp plication was performed in 34% (n = 17) of patients and commissure repair in 8% (n = 4) of patients. There were no in-hospital deaths, and 1 patient (2%) had a perioperative stroke. The 1-, 5-, 10- and 20-year survival rates of patients after discharge were 98%, 94%, 88% and 84%, respectively. The rates for freedom from valve-related reoperation at 1, 5, 10 and 20 years after initial surgery were 98%, 88%, 79% and 74%, respectively. Long-term freedom from reoperation was comparable to that of patients with tricuspid aortic valves (P = 0.2). CONCLUSIONS The David procedure has excellent short-term results in patients with a bicuspid aortic valve. In this study, the long-term durability of reimplanted bicuspid aortic valves was comparable to that of tricuspid valves. However, careful patient selection might have contributed to this, and further studies might be needed to definitely clarify this issue.

Download Full-text

A retrospective analysis of mitral valve pathology in the setting of bicuspid aortic valves

Echo Research and Practice ◽

10.1530/erp-17-0016 ◽

2017 ◽

Vol 4 (2) ◽

pp. 21-28 ◽

Cited By ~ 2

Author(s):

Annari van Rensburg ◽

Philip Herbst ◽

Anton Doubell

Keyword(s):

Mitral Valve ◽

Aortic Valve ◽

Retrospective Analysis ◽

Bicuspid Aortic Valve ◽

Valve Leaflet ◽

Aortic Valves ◽

Mitral Valve Leaflet ◽

Therapeutic Implications ◽

Transcatheter Aortic Valve ◽

Bicuspid Aortic Valves

The therapeutic implications of bicuspid aortic valve associations have come under scrutiny in the transcatheter aortic valve implantation era. We evaluate the spectrum of mitral valve disease in patients with bicuspid aortic valves to determine the need for closer echocardiographic scrutiny/follow-up of the mitral valve. A retrospective analysis of echocardiograms done at a referral hospital over five years was conducted in patients with bicuspid aortic valves with special attention to congenital abnormalities of the mitral valve. One hundred and forty patients with a bicuspid aortic valve were included. A congenital mitral valve abnormality was present in eight (5.7%, P = 0.01) with a parachute mitral valve in four (2.8%), an accessory mitral valve leaflet in one (0.7%), mitral valve prolapse in one, a cleft in one and the novel finding of a trileaflet mitral valve in one. Minor abnormalities included an elongated anterior mitral valve leaflet (P < 0.001), the increased incidence of physiological mitral regurgitation (P < 0.001), abnormal papillary muscles (P = 0.002) and an additional chord or tendon in the left ventricle cavity (P = 0.007). Mitral valve abnormalities occur more commonly in patients with bicuspid aortic valves than matched healthy individuals. The study confirms that abnormalities in these patients extend beyond the aorta. These abnormalities did not have a significant functional effect.

Download Full-text

Congenital bicuspid aortic valve a case report

Journal of Dhaka Medical College ◽

10.3329/jdmc.v23i1.22708 ◽

2015 ◽

Vol 23 (1) ◽

pp. 128-130

Author(s):

Md Rasul Amin ◽

Md Nazmul Hasan ◽

Masuma Begum ◽

Md Tarique Mehedi

Keyword(s):

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Congenital Heart ◽

Treatment Plan ◽

Aortic Valves ◽

Medical College ◽

Subsequent Investigation ◽

Evaluation Time ◽

Bicuspid Aortic Valves ◽

Degrees Of Severity

Among all the congenital heart disease, bicuspid aortic valves (BAVs) are cardiac valvular anomaly, occurring in 12% of the general population. It is twice as common in males as in females. In many cases, a bicuspid aortic valve will cause no problems. However, BAV may become calcified later in life, which may lead to varying degrees of severity of aortic stenosis that will manifest as murmurs. If the leaflets do not close correctly, aortic regurgitation can occur. These mixed clinical finding sometimes confuses physician and culminating to considering other differentials, needs further more subsequent investigation and imaging, thus prolonging evaluation time and delaying decision making for treatment plan. DOI: http://dx.doi.org/10.3329/jdmc.v23i1.22708 J Dhaka Medical College, Vol. 23, No.1, April, 2014, Page 128-130

Download Full-text

Bicuspid Aortic Valve Presenting with Severe Stenosis and Regurgitation - A Case Report with Review

University Heart Journal ◽

10.3329/uhj.v9i1.19517 ◽

2014 ◽

Vol 9 (1) ◽

pp. 64-66

Author(s):

Md Nazmul Hasan ◽

Md Abu Siddique ◽

Sajal Krishna Banerjee ◽

CM Ahmed ◽

Naveen Sheikh ◽

...

Keyword(s):

Decision Making ◽

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Treatment Plan ◽

Aortic Valves ◽

Severe Stenosis ◽

Subsequent Investigation ◽

Evaluation Time ◽

Bicuspid Aortic Valves ◽

Degrees Of Severity

Bicuspid aortic valves (BAV) are cardiac valvular anomaly, occurring in 12% of the general population. It is twice as common in males as in females.In many cases, a bicuspid aortic valve will cause no problems.However BAV may become calcified later in life, which may lead to varying degrees of severity of aortic stenosis that will manifest asmurmurs. If the leaflets do not close correctly, aortic regurgitation can occur. These mixed clinical finding sometimes confuses physician and culminating to considering other differentials, needs further more subsequent investigation and imaging, thus prolonging evaluation time and delaying decision making for treatment plan. DOI: http://dx.doi.org/10.3329/uhj.v9i1.19517 University Heart Journal Vol. 9, No. 1, January 2013; 64-66

Download Full-text

The circle method for preoperative TAVI sizing in a Sievers type 0 stenotic bicuspid aortic valve

10.1510/mmcts.2021.050 ◽

2021 ◽

Keyword(s):

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Circle Method ◽

Ascending Aorta ◽

Cardiac Anomaly ◽

Aortic Valves ◽

Congenital Cardiac Anomaly ◽

Video Tutorial ◽

Transcatheter Heart Valve ◽

Valve Annulus

The most common congenital cardiac anomaly, affecting an estimated 0.4–2.25% of the general population, is the bicuspid aortic valve. The “pure” bicuspid aortic valve (non-raphe-type or bicuspid aortic valve type 0) is composed of 2 cusps, morphologically and functionally. The shape of the bicuspid aortic valve annulus is often elliptical, is relatively larger than the tricuspid aortic valves, and probably shows severe eccentric calcification. This situation contributes to the difficulties in selecting the correct type and size of transcatheter heart valve when treating bicuspid aortic valve stenosis. Furthermore, it is often associated with a dilated, horizontal ascending aorta and effaced sinuses. The goal of our video tutorial is to present the contemporary circle method used in preoperative sizing during TAVI procedures in patients with a bicuspid aortic valve as well as certain technical considerations and useful advice. Although annular sizing is the main focus for most patients with a bicuspid aortic valve, some patients may need the supra-annular level of sizing. For a dedicated sizing and positioning approach for the SAPIEN 3 Ultra valve, experts in the field propose the circle method.

Download Full-text