PROGRESSION OF AORTIC REGURGITATION IN BICUSPID AORTIC VALVE

Bicuspid aortic valve (BAV) is a common congenital disorder. It could simply be a minor anatomic abnormality or be associated with progressive aortic stenosis, aortic regurgitation, and aortic dilation. If an athlete is recognized to have a BAV, questions arise with regard to whether they can pursue their selected sports, particularly elite athletic activity, and what type of follow-up examinations are necessary and how often should be done. Valvular disorders such as the degree of aortic stenosis and aortic regurgitation, aortic size, and coexisting disorders are also influencing factors. The absence of robust controlled studies, which are difficult to perform, make decision-making difficult, although recommendations by expert panels provide some guidance. The general consensus is that athletes with BAV with normal valvular function and no aortic dilation can participate in all athletic activities. Those with mild aortic dilation should undergo annual screening, some more frequently than others. Those with moderate or severe valvular stenosis or regurgitation should be managed based on the haemodynamic impact of the valve lesion. Athletes with coexisting lesions or syndromes should be evaluated comprehensively. The overall recommendation to an individual athlete should incorporate many factors and employ a multidisciplinary approach.

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Anatomical and clinical predictors of valve dysfunction and aortic dilation in bicuspid aortic valve disease

Heart ◽

10.1136/heartjnl-2017-311560 ◽

2017 ◽

Vol 104 (7) ◽

pp. 566-573 ◽

Cited By ~ 26

Author(s):

Arturo Evangelista ◽

Pastora Gallego ◽

Francisco Calvo-Iglesias ◽

Javier Bermejo ◽

Juan Robledo-Carmona ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Regurgitation ◽

Bicuspid Aortic Valve ◽

Aortic Root ◽

Ascending Aorta ◽

Clinical Predictors ◽

Valve Dysfunction ◽

Tertiary Hospitals ◽

Male Sex

ObjectiveBicuspid aortic valve (BAV) is associated with early valvular dysfunction and proximal aorta dilation with high heterogeneity. This study aimed to assess the determinants of these complications.MethodsEight hundred and fifty-two consecutive adults diagnosed of BAV referred from cardiac outpatient clinics to eight echocardiographic laboratories of tertiary hospitals were prospectively recruited. Exclusion criteria were aortic coarctation, other congenital disorders or intervention. BAV morphotype, significant valve dysfunction and aorta dilation (≥2 Z-score) at sinuses and ascending aorta were established.ResultsThree BAV morphotypes were identified: right–left coronary cusp fusion (RL) in 72.9%, right–non-coronary (RN) in 24.1% and left–non-coronary (LN) in 3.0%. BAV without raphe was observed in 18.3%. Multivariate analysis showed aortic regurgitation (23%) to be related to male sex (OR: 2.80, p<0.0001) and valve prolapse (OR: 5.16, p<0.0001), and aortic stenosis (22%) to BAV-RN (OR: 2.09, p<0.001), the presence of raphe (OR: 2.75, p<0.001), age (OR: 1.03; p<0.001), dyslipidaemia (OR: 1.77, p<0.01) and smoking (OR: 1.63, p<0.05). Ascending aorta was dilated in 76% without differences among morphotypes and associated with significant valvular dysfunction. By contrast, aortic root was dilated in 34% and related to male sex and aortic regurgitation but was less frequent in aortic stenosis and BAV-RN.ConclusionsNormofunctional valves are more prevalent in BAV without raphe. Aortic stenosis is more frequent in BAV-RN and associated with some cardiovascular risk factors, whereas aortic regurgitation (AR) is associated with male sex and sigmoid prolapse. Although ascending aorta is the most commonly dilated segment, aortic root dilation is present in one-third of patients and associated with AR. Remarkably, BAV-RL increases the risk for dilation of the proximal aorta, whereas BAV-RN spares this area.

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Bicuspid Aortic Valve and Severe Aortic Regurgitation with Dilation of the Sinus of Valsalva

Echocardiographic Atlas of Adult Congenital Heart Disease ◽

10.1007/978-3-319-12934-1_101 ◽

2015 ◽

pp. 325-327

Author(s):

Hakimeh Sadeghian ◽

Zahra Savand-Roomi

Keyword(s):

Aortic Valve ◽

Aortic Regurgitation ◽

Bicuspid Aortic Valve ◽

Sinus Of Valsalva ◽

Severe Aortic Regurgitation

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Bicuspid aortic valve with severe aortic stenosis: a case report

Bangladesh Medical Journal ◽

10.3329/bmj.v44i2.27253 ◽

2016 ◽

Vol 44 (2) ◽

pp. 105-108

Author(s):

Redoy Ranjan ◽

Md Mushfiqur Rahman ◽

Omar Sadeque Khan ◽

Md Aftabuddin ◽

Asit Baran Adhikary

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Aortic Regurgitation ◽

Valve Replacement ◽

Bicuspid Aortic Valve ◽

Severe Aortic Stenosis ◽

Color Doppler ◽

Flow Through ◽

High Record

A bicuspid aortic valve (BAV) can be a serious disorder of heart valve in which the valve only has two leaflets or flaps that control blood flow through the heart. Between one and two percent of all people have this defect and it affects more men than women. This report presents a case of severe aortic stenosis with mild to moderate aortic regurgitation due to bicuspid aortic valve with hypertension. A 37 years old male presented with high record of blood pressure and occasional shortness of breath on exertion. Echocardiography (Color Doppler) revealed severe aortic stenosis with mild to moderate aortic regurgitation due to bicuspid aortic valve with moderately severe concentric LV wall hypertrophy. Surgical treatment (aortic valve replacement) was scheduled based on echocardiography findings. On surgical resection a well defined bicuspid aortic valve was found with calcification and friable valve leaflet. Histopathology of valve tissue shows large areas of calcification. Patient was discharged from hospital on 7th POD with an advice to attend cardiac surgery OPD after 1 month. Aortic valve replacement must be considered in this type of lesion.Bangladesh Med J. 2015 May; 44 (2): 105-108

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