Abstract 19684: Abnormal Aortic Wall Properties in Children with Isolated Bicuspid Aortic Valve

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Shobha S Natarajan ◽  
Andrew C Glatz ◽  
Elizabeth Goldmuntz ◽  
Meryl S Cohen
Keyword(s):  
Aortic Valve ◽  
Diastolic Function ◽  
Bicuspid Aortic Valve ◽  
Aortic Wall ◽  
Left Ventricular ◽  
Age Group ◽  
Valve Morphology ◽  
Wall Properties ◽  
Z Scores ◽  
The Impact

Introduction: Abnormal aortic wall properties have been reported in patients with isolated bicuspid aortic valve (IBAV) even in the absence of significant aortic stenosis or regurgitation. Hypothesis: We sought to assess aortic distensibility (DIS) and stiffness index (SI) in children with IBAV compared to age group-matched subjects with normal tricuspid aortic valves (TAV) and to determine whether these abnormalities in the aortic wall properties correlate with bicuspid valve morphology or left ventricular systolic or diastolic function. Methods: Children ages 8-18 years with an IBAV and age group-matched controls with a TAV were prospectively enrolled. Subjects with greater than mild stenosis or mild regurgitation were excluded. Using echo, aortic valve morphology, aortic root (AoR) and ascending aorta (AAo) diameters and z-scores were determined. Left ventricular shortening fraction (LVSF), DIS and SI were measured using M-mode echo. Diastolic function was determined using mitral valve septal E/Ea. Blood pressure (BP) was measured at the time of echo. Results: Nineteen had IBAV and 17 had TAV. There were no significant differences in age, weight, height or BP between the two groups. In the IBAV group, 11 had right-left type (R/L) and 8 had right-non type (R/N). There was no significant difference in AoR z-scores between groups. The IBAV group had larger AAo z-scores (2.48±1.9 vs. -0.02±0.98, p<0.0001), decreased DIS (9.6±4 vs. 12.3±3.1 cm2 dynes-1 x 10-6, p<0.05) and increased SI (21.4±9.2 vs. 14.4±3.8, p=0.007) compared to the TAV group. There were no differences in these variables between the R/L or R/N subgroups. No correlation was seen between aortic wall properties and ventricular function in the IBAV group. By multivariate regression, presence of an IBAV (coefficient = -2.4, p=0.03), LVSF (coefficient = -0.35, p=0.01) and age-adjusted systolic BP (coefficient = -0.13, p=0.03) were independently associated with DIS. Similarly, presence of an IBAV (coefficient = 6.7, p=0.005) and age (coefficient=0.85, p=0.02) were independently associated with SI. Conclusions: Children with IBAV have decreased DIS and SI even without hemodynamic abnormalities. Long-term studies to determine the impact of these findings on cardiovascular risk are needed.

scholarly journals P291 Additional value of myocardial work in detecting subclinical systolic dysfunction in patients with bicuspid aortic valve and left ventricular hypertrophy

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M E Canonico ◽  
C Santoro ◽  
M Prastaro ◽  
R Sorrentino ◽  
F Luciano ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Ejection Fraction ◽  
Bicuspid Aortic Valve ◽  
Pulse Pressure ◽  
Speckle Tracking ◽  
Left Ventricular ◽  
Lv Mass ◽  
Significant Difference ◽  
Global Work ◽  
The Impact

Abstract Background An impairment of speckle tracking derived left ventricular (LV) global longitudinal strain (GLS) has been observed in patients with bicuspid aortic valve (BAV) and referred to abnormalities of aortic elasticity properties. The impact of LV mass on myocardial deformation has still not been investigated. This issue can be now better addressed by myocardial work software, which incorporates both deformation and hemodynamic load in the analysis. Aim of the study To analyse the impact of both deformation and strain derived myocardial work in BAV patients with and without LV hypertrophy (LVH). Methods Sixty-five patients with BAV underwent a comprehensive echo exam, including speckle tracking derived calculation of GLS (in absolute value). Parameters of myocardial work such as global work index (GWI), global constructive work (GCW) global wasted work (GWW) and global work efficiency (GWE) were measured according to standardized procedures. Patients with reduced LV ejection fraction and with more than mild aortic stenosis and/or regurgitation were excluded. Other exclusion criteria included coronary artery disease, concomitant valvular heart disease, heart failure, primary cardiomyopathies, permanent and/or persistent atrial fibrillation and inadequate echo images. BAV patients were divided according to presence of LVH: 10 with LVH (LV mass index &gt;47 g/m^2.7 in women and &gt;50 g/m^2.7 in men) and 55 without LVH. Results The two groups were comparable for sex, age and heart rate whereas systolic blood pressure (p = 0.006) and pulse pressure (p = 0.002) were higher in patients with LVH, who also had higher relative diastolic wall thickness (p &lt; 0.02). No significant difference in ejection fraction (p = 0.56), transmitral E/A ratio (p = 0.504) and E/e" (p = 0.311) was found between the two groups. GLS (19.1 ± 2.5 in LVH group and. 20.0 ± 2.4% in patients without LVH, p = 0.290), GWI (p = 0.356) and GCW (p = 0.396) did not differ significantly whereas GWW was higher (119.5 ± 72.9 vs. 72.3 ± 38.7 mmHg%, p = 0.003) and GWE lower (94.4 ± 3.0 vs. 92.2 ± 1.6%, p = 0.007) in BAV patients with LVH (Figure). In the pooled population, LV mass index was related with GWW (r = 0.26, p = 0.03) and GWE (r=-0.30, p &lt; 0.01) but not with GLS (r=-0.22, p = 0.08). The relation between GWE and LV mass index remained significant even after adjusting for pulse pressure (partial r=-0.28, p &lt; 0.02). Conclusion In patients with BAV, LVH plays a detrimental effect on LV systolic function which cannot be identified by ejection fraction and GLS assessment but is unmasked by the application of myocardial work. In presence of LVH, the wasted work of BAV patients is increased and myocardial efficiency is substantially reduced, it being negatively related to LV mass even after adjusting for a raw index of aortic stiffness such as pulse pressure. Abstract P291 Figure. GLS, GWW and GWE according to LVH

scholarly journals Relation Between Left Ventricular Diastolic Function and Arterial Stiffness in Patients with Bicuspid Aortic Valve

2013 ◽  
Vol 62 (18) ◽  
pp. C178
Author(s):  
Gonenc Kocabay ◽  
Can Yucel Karabay ◽  
Sedat Kalkan ◽  
Arzu Kalayci ◽  
Suleyman Cagan Efe ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Arterial Stiffness ◽  
Diastolic Function ◽  
Bicuspid Aortic Valve ◽  
Left Ventricular Diastolic Function ◽  
Left Ventricular ◽  
Ventricular Diastolic Function

scholarly journals 90 Annular size and interaction with trans-catheter aortic valves for the treatment of severe bicuspid aortic valve stenosis: insights from the beat registry

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Elisabetta Moscarella ◽  
Antonio Mangieri ◽  
Francesco Giannini ◽  
Didier Tchetchè ◽  
Won-keun Kim ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Clinical Outcomes ◽  
Bicuspid Aortic Valve ◽  
Academic Research ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Aortic Valve Area ◽  
Ventricular Ejection Fraction ◽  
Transcatheter Aortic Valve ◽  
The Impact

Abstract Aims Transcatheter aortic valve replacement (TAVR) is safe and feasible in patients with bicuspid aortic valve (BAV), but whether annular size may influence TAVR results in BAV patients remains unclear. We aimed at evaluating the impact of aortic annular size on procedural and clinical outcomes of BAV patients undergoing TAVR, as well as potential interactions between annular dimension and trans-catheter heart valve (THV) type [balloon-expandable (BEV) vs. self-expanding (SEV)]. Methods and results BEAT is a multicentre registry of consecutive BAV stenosis undergoing TAVR. For this sub-study patients were classified according to annular dimension in small-annulus (area &lt; 400 mm2 or perimeter &lt;72 mm), medium-annulus (area ≥ 400 and &lt; 575 mm2, perimeter ≥72 mm and&lt; 85 mm), large-annulus (area ≥575 mm2 or perimeter ≥85 mm). Primary endpoint was Valve Academic Research Consortium-2 (VARC-2) device success. 45(15.5%) patients had small, 132(45.3%) medium, and 114(39.2%) large annuli. Compared with other groups, patients with large annuli were more frequently male, at younger age, had higher body mass index, larger aortic valve area, higher rate of moderate-severe calcification, lower mean trans-aortic valve gradient and lower left ventricular ejection fraction. In large-annuli SEVs were associated with a lower VARC-2 device success (75.9% vs. 90.6%, P = 0.049) driven by a higher rate of paravalvular valvular leak (PVL) compared to BEVs (20.7% vs. 1.2%, P &lt; 0.001). However, no differences in clinical outcomes were observed according to annular size nor THV type. Conclusions TAVR in BAV patients is feasible irrespective of annular size. However in patients with large aortic annulus SEVs were associated with a significantly higher rate of PVLs compared to BEVs.

scholarly journals Impaction of regurgitation jet on anterior mitral leaflet is associated with diastolic dysfunction in patients with bicuspid aortic valve and mild insufficiency: a cardiovascular magnetic resonance study

2021 ◽  
Author(s):  
Nicola Galea ◽  
Giacomo Pambianchi ◽  
Giulia Cundari ◽  
Francesco Sturla ◽  
Livia Marchitelli ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Left Ventricular ◽  
Control Group ◽  
Cardiovascular Magnetic Resonance Study ◽  
Flow Imaging ◽  
4D Flow ◽  
The Impact ◽  
4D Flow Imaging

AbstractTo assess the impact of regurgitant jet direction on left ventricular function and intraventricular hemodynamics in asymptomatic patients with bicuspid aortic valve (BAV) and mild aortic valve regurgitation (AR), using cardiac magnetic resonance (CMR) feature tracking and 4D flow imaging. Fifty BAV individuals were retrospectively selected: 15 with mild AR and posterior regurgitation jet (Group-PJ), 15 with regurgitant jet in other directions (Group-nPJ) and 20 with no regurgitation (Controls). CMR protocol included cine steady state free precession (SSFP) sequences and 4D Flow imaging covering the entire left ventricle (LV) cavity and the aortic root. Cine-SSFP images were analyzed to assess LV volumes, longitudinal and circumferential myocardial strain. Circumferential and longitudinal peak diastolic strain rate (PDSR) and peak diastolic velocity (PDV) were reduced in group PJ if compared to group nPJ and control group (PDSR = 1.10 ± 0.2 1/s vs. 1.34 ± 0.5 1/s vs. 1.53 ± 0.3 1/s, p:0.001 and 0.68 ± 0.2 1/s vs. 1.17 ± 0.2 1/s vs. 1.05 ± 0.4 1/s ; p < 0.001, PDV = − 101.6 ± 28.1 deg/s vs. − 201.4 ± 85.9 deg/s vs. − 221.6 ± 67.1 deg/s; p < 0.001 and − 28.1 ± 8 mm/s vs. − 38.9 ± 11.1 mm/s vs. − 43.6 ± 14.3 mm/s, p < 0.001, respectively), whereas no differences have been found in systolic strain values. 4D Flow images (available only in 9 patients) showed deformation of diastolic transmitral streamlines direction in group PJ compared to other groups. In BAV patients with mild AR, the posterior direction of the regurgitant jet may hamper the complete mitral valve opening, disturbing transmitral flow and slowing the LV diastolic filling.

LETTER TO THE EDITOR: Relationship between Bicuspid Aortic Valve Morphology and Aortic Wall Degeneration: Further Evidence Is Emerging

2010 ◽  
Vol 27 (8) ◽  
pp. 1028-1028
Author(s):  
Aldo Cannata ◽  
Claudio Francesco Russo ◽  
Luigi Martinelli
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Aortic Wall ◽  
Valve Morphology ◽  
Letter To The Editor

scholarly journals Impaction of Regurgitation Jet on Anterior Mitral Leaflet Causes Diastolic Dysfunction in Patients With Bicuspid Aortic Valve and Mild Insufficiency: A Cardiovascular Magnetic Resonance Study

2021 ◽  
Author(s):  
Nicola Galea ◽  
Giacomo Pambianchi ◽  
Giulia Cundari ◽  
Francesco Sturla ◽  
Livia Marchitelli ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Left Ventricular ◽  
Control Group ◽  
Cardiovascular Magnetic Resonance Study ◽  
Flow Imaging ◽  
4D Flow ◽  
The Impact ◽  
4D Flow Imaging

Abstract Purpose: To assess the impact of regurgitant jet direction on left ventricular function and intraventricular hemodynamics in asymptomatic patients with bicuspid aortic valve (BAV) and mild aortic valve regurgitation (AR), using cardiac magnetic resonance (CMR) feature tracking and 4D flow imaging.Methods: Fifty BAV individuals were retrospectively selected: 15 with mild AR and posterior regurgitation jet (Group-PJ), 15 with regurgitant jet in other directions (Group-nPJ) and 20 with no regurgitation (Controls). CMR protocol included cine steady state free precession (SSFP) sequences and 4D Flow imaging covering the entire left ventricle (LV) cavity and the aortic root. Cine-SSFP images were analyzed to assess LV volumes, longitudinal and circumferential myocardial strain.Results: Circumferential and longitudinal peak diastolic strain rate (PDSR) and peak diastolic velocity (PDV) were reduced in group PJ if compared to group nPJ and control group (PDSR = 1.10±0.2 s-1 vs 1.34±0.5 s-1 vs 1.53±0.3 s-1 , p:0.001 and 0.68±0.2 s-1 vs 1.17±0.2 s-1 vs 1.05±0.4 s-1 ; p<0.001, PDV = -101.6±28.1 deg/s vs -201.4±85.9 deg/s vs - 221.6±67.1 deg/s; p<0.001 and -28.1±8 mm/s vs -38.9±11.1 mm/s vs -43.6±14.3 mm/s, p<0.001, respectively), whereas no differences have been found in systolic strain values. 4D Flow images (available only in 9 patients) showed deformation of diastolic transmitral streamlines direction in group PJ compared to other groups.Conclusion: In BAV patients with AR, the posterior direction of the regurgitant jet may hamper the complete mitral valve opening, disturbing transmitral flow and slowing the LV diastolic filling

Response to Letter Regarding: Relationship between Bicuspid Aortic Valve Morphology and Aortic Wall degeneration: Further Evidence Is Emerging

2010 ◽  
Vol 27 (8) ◽  
pp. 1029-1029
Author(s):  
Davinder S. Jassal ◽  
Kapil M. Bhagirath ◽  
James W. Tam ◽  
Kwan L. Chan
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Aortic Wall ◽  
Valve Morphology

scholarly journals The impact of the aortic cusps fusion pattern and valve disease severity on the aortic wall mechanics in patients with bicuspid aortic valve

2020 ◽  
Vol 36 (8) ◽  
pp. 1429-1436
Author(s):  
Mariusz E. Kalinowski ◽  
Mariola Szulik ◽  
Szymon Pawlak ◽  
Barbara Rybus-Kalinowska ◽  
Marian Zembala ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Disease Severity ◽  
Bicuspid Aortic Valve ◽  
Aortic Wall ◽  
Valve Disease ◽  
The Impact
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