Materiały źródłowe

• #1 Bicuspid aortic valve; optimal diagnosis and latest interventional treatment | mijn-bsl

  https://mijn.bsl.nl/bicuspid-aortic-valve-optimal-diagnosis-and-latest-interventiona/620314

  Bicuspid aortic valve (BAV) is one of the most common congenital heart defects with a population prevalence of 0.5 to 1.3 %. […] Patients with BAV frequently remain undiagnosed until the manifestation of symptoms. Therefore, early screening and detection of patients is warranted. Imaging of a severely stenotic aortic valve is challenging. […] From a cost-effectiveness perspective, echocardiography will still be the first choice in BAV patients. When the echocardiograms are difficult to analyse or when in doubt, CMR can be useful to come to a diagnosis. […] To summarise, to diagnose patients with BAV, echocardiography remains the first choice. However, when the echocardiograms are difficult to analyse or for careful evaluation of the progression of aortic diameters, CMR is very useful to come to a diagnosis. MSCT is increasingly being used to accurately size the aortic root diameters.

• #1 Bicuspid Aortic Valve Causes and Diagnoses | Northwestern Medicine

  https://www.nm.org/conditions-and-care-areas/heart-and-vascular/conditions-and-treatments/bicuspid-aortic-valve/causes-and-diagnoses

  While it is the most common congenital heart disorder, the cause of bicuspid aortic valve (BAV) is not completely clear. […] One of the earliest indicators of BAV may be a heart murmur. A heart murmur is an abnormal sound caused by the turbulent flow of blood over a diseased heart valve. […] Hearing a heart murmur may trigger a cardiologist to order an echocardiogram (ECHO) to determine if you have BAV. An ECHO is a painless test that uses sound waves to create a moving picture of the heart. It is the most accurate way of diagnosing BAV. […] If you are diagnosed with BAV, you should receive ongoing care from a cardiologist with experience in heart valve disease. […] Current recommendations are for all first-degree relatives (parents, siblings, children) of someone diagnosed with BAV to be screened. Early diagnosis of BAV allows the patient to be followed prior to the disease causing symptoms and complications.

• #1 Aortic valve disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/aortic-valve-disease/diagnosis-treatment/drc-20355122

  To diagnose aortic valve disease, a health care professional examines you and asks questions about your symptoms and medical history. […] A whooshing sound, called a heart murmur, may be heard when listening to the heart with a stethoscope. If so, you may need to see a doctor trained in heart diseases, called a cardiologist. […] Tests to diagnose aortic valve disease include: […] An echocardiogram uses sound waves to create pictures of the beating heart. It shows how blood flows through the heart and heart valves. It can help determine the severity of aortic valve disease. […] A cardiac MRI uses magnetic fields and radio waves to create detailed pictures of the heart. This test may be used to determine the severity of aortic valve disease and measure the size of the aorta. […] A cardiac CT scan uses a series of X-rays to create detailed images of the heart and heart valves. The test may be done to measure the size of the aorta and look at the aortic valve more closely. A CT scan also may be used to measure the amount of calcium in the aortic valve or determine the severity of aortic valve stenosis.

• #1 Aortic Stenosis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/0915/p717.html

  Classic symptoms of aortic stenosis include dyspnea and other symptoms of heart failure, angina, and syncope. The onset of these classic symptoms indicates hemodynamically significant aortic stenosis and is a critical point for making management decisions. […] Doppler echocardiography is the recommended initial test for patients with classic symptoms of aortic stenosis. It is helpful for estimating aortic valve area, peak and mean transvalvular gradients, and maximum aortic velocity. These are the primary measures for assessing disease severity, and they have been well validated compared with measurement obtained with cardiac catheterization. […] Echocardiography also provides useful information about LV function, left ventricular filling pressure, and coexisting abnormalities of other valves. Guidelines for relating these hemodynamic measures to severity of aortic stenosis are presented in Table 1. Isolated aortic stenosis rarely becomes symptomatic until the aortic valve area is less than 1 cm2, the mean gradient is greater than 40 mm Hg, or the aortic jet velocity is greater than 4 m per second.

• #1 Bicuspid aortic valve | Health Library | Memorial Health System

  https://www.mhsystem.org/health-library/con-20359710/

  A bicuspid aortic valve may be found when tests are done for another health concern. The healthcare professional may hear a heart murmur when listening to the heart. […] An echocardiogram can confirm a diagnosis of bicuspid aortic valve. This test uses sound waves to create videos of the beating heart. It shows how blood moves through the heart chambers, the heart valves and the aorta. […] If you have a bicuspid aortic valve, you usually have a CT scan to check for changes in the aorta’s size.

• #1 Bicuspid Aortic Valve Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/893523-workup

  Two-dimensional echocardiography provides accurate confirmation of a bicuspid aortic valve. […] Imaging can show the bicuspid aortic valve in multiple planes. Most important information is obtained from the parasternal long-axis and short-axis views. […] Magnetic resonance imaging (MRI) is generally helpful for the diagnosis of bicuspid aortic valve and for complete assessment of the aortic root and thoracic aorta, particularly in cases of aortic root dilatation or dissection, coarctation, Turner syndrome, or Williams syndrome. Quantitative assessment of aortic valve regurgitation and left ventricular volumes are helpful in assessment of severity. […] Physical examination and if indicated, two-dimensional echocardiography are recommended as a screening tool for the offspring and first-degree relatives (especially males) of patients identified as having a bicuspid aortic valve because a high recurrence rate (as much as 12-17%) has been shown in several families.

• #1 Bicuspid Aortic Valve Symptoms, Diagnosis, & Treatment

  https://myheart.net/articles/bicuspid-aortic-valve/

  An ultrasound scan of the heart known as echocardiography is typically used to diagnose bicuspid aortic valve. This will allow assessment of the valve structure, and look for associated valve tightening (aortic stenosis) or leakiness (aortic regurgitation). Importantly this will also allow assessment of the aorta and to assess widening of the aorta in the chest (aortic aneurysm). […] Sometimes standard echocardiography isn’t able to accurately assess the valve and so it can be difficult to differentiate between a normal tricuspid, and a bicuspid valve. Transesophageal echocardiography is much more accurate, however that involves passing a small camera in to the stomach to take close pictures of the heart and is therefore not done routinely. […] Therefore CT or MRI imaging is recommended in those patients who do not have adequate echo pictures. MRI is generally preferred as it avoids the need for radiation exposure; particularly in those who need repeated follow up studies for surveillance.

• #1 Diagnosis and Outcomes of Transcatheter Aortic Valve Implantation in Bicuspid Aortic Valve Stenosis | ICR Journal

  https://www.icrjournal.com/articles/diagnosis-and-outcomes-transcatheter-aortic-valve-implantation-bicuspid-aortic-valve

  Bicuspid aortic valve is the most common congenital cardiac malformation. […] Recently, the diagnosis and classification of bicuspid aortic valve based on multidetector computed tomography (MDCT) assessment has been proposed, which may have an impact of outcomes after TAVI. […] This review article describes the advancements in diagnosis and outcomes of bicuspid AS. […] Pre-procedural MDCT assessment of aortic valve has become standardised in the TAVI era, and pre-procedural diagnosis of bicuspid AS with MDCT has gained considerable attention. […] With accumulation of experience in MDCT assessments of aortic valves, the great variety of bicuspid AS morphology has been observed, leading Jilaihawi et al. to propose a more simplified, TAVI-directed classification of bicuspid aortic valve.

• #1 Bicuspid Aortic Valve | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/b/bicuspid-aortic-valve.html

  How is bicuspid aortic valve diagnosed? Your healthcare provider will ask about your symptoms and past health. You will also need a physical exam. Some tests can also help with the diagnosis. These include: […] Echocardiography. This is the most important test. It shows the movement of blood through the valve using ultrasound. […] Transesophageal echocardiography. This is a heart ultrasound done from the esophagus that can give better pictures of the aortic valve. […] Electrocardiogram. This is done to check the hearts electrical rhythm. […] Chest X-ray. These help view the heart anatomy and lungs. […] Cardiac CT or MRI. These are done if more detail is needed about the valve, heart, or aorta. […] Sometimes, bicuspid aortic valve first appears on an echocardiogram done for other reasons. A cardiologist might first diagnose it.

• #1 Clinical manifestations and diagnosis of bicuspid aortic valve in adults – UpToDate

  https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-bicuspid-aortic-valve-in-adults

  This topic will discuss the clinical presentation and diagnosis of bicuspid aortic valve. […] The anatomy of the bicuspid aortic valve includes unequal cusp size (generally due to fusion of two cusps producing the larger of two cusps), a raphe, and smooth cusp margins. A raphe or fibrous ridge is the site of fusion of the two conjoined cusps and is identifiable in most cases. There is a wide spectrum of bicuspid aortic valves, including partial or complete leaflet fusion, the presence or absence of a raphe or multiple raphes, and different orientations of the true commissures. The right and left coronary leaflets are the most commonly fused (70 to 86 percent) with the true commissures oriented in anterior-posterior position (typical pattern). Right and noncoronary leaflet fusion with right-left leaflet orientation (atypical pattern) occurs in 12 percent, while left and noncoronary leaflet fusion (3 percent) is the least common type of bicuspid aortic valve. The coronary arteries usually arise in front of the cusps in which a raphe is present.

• #1 Clinical manifestations and diagnosis of bicuspid aortic valve in adults – UpToDate

  https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-bicuspid-aortic-valve-in-adults

  Leaflet orientation may affect valve function with fusion of the right and noncoronary leaflet associated with greater valvular dysfunction. Leaflet orientation may also predict the pattern of aortopathy and is associated with differential regional aortic wall stress. Calcification of the bicuspid aortic valve increases with age and occurs more rapidly than that seen with tricuspid aortic valve. There is abnormal leaflet motion and turbulence during the cardiac cycle in bicuspid aortic valves and this may play a role in premature degeneration.

• #1 Diagnostic accuracy study of routine echocardiography for bicuspid aortic valve: a retrospective study and meta-analysis – Hillebrand – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/15133/16420

  Transthoracic echocardiography (TTE) is the standard procedure to distinguish tricuspid aortic valve (TAV) from bicuspid aortic valve (BAV). […] Guidelines recommend transthoracic echocardiography (TTE) as the standard procedure to diagnose BAV. […] The current study shows that TTE yields almost ideal diagnostic accuracy when ideal investigators examine ideal patients. However, the study also shows that TTE yields suboptimal diagnostic accuracy under routine conditions. TTE in non-tertiary care settings, concomitant aortic aneurysm, and presence of severe aortic valve calcification predict an inaccurate diagnosis of BAV. […] The study showed that the primary investigators sensitivity of routine echocardiography for BAV was only 46.3%. The sensitivity was significantly higher with expert re-evaluation of original TTE recordings, but with 59.7% it still remained suboptimal. […] The meta-analysis of previously published studies demonstrated a pooled sensitivity of 87.7% for BAV which was significantly higher than in the current study.

• #1

  https://link.springer.com/article/10.1007/s10554-024-03290-w

  Bicuspid aortic valfves (BAV) are a relatively common cardiac abnormality, with an associated risk of aortic stenosis, aortic regurgitation and aortopathy. First-line diagnosis is via transthoracic echocardiography (TTE), which may be impacted by valve calcification and operator variability. Electrocardiogram-gated computed tomography (CT) offers an alternative form of assessment. The aim of this systematic review and meta-analysis is to evaluate the diagnostic performance of TTE versus CT for BAV. […] There was a significant difference between the sensitivity of retrospectively ECG-gated cardiac CT (95.5% (95% CI: [91.3-97.5%]) and TTE (79.7%, 95% CI: [71.6-86.0%]) for identifying BAV. The specificity was high and not significantly different for both CT and TTE (96%, 95% CI: [92.5-98.2%] and 91.3%, 95% CI: [87.3-93.8%], respectively). Retrospectively ECG-gated CT demonstrates greater sensitivity for diagnosis of BAV compared to TTE. Both modalities are non-invasive and demonstrate good specificity for excluding BAV. Given that CT scans are easily accessible, they offer a reasonable second-line investigation for diagnosis of BAV when an initial TTE is inconclusive.

• #1 Speaking a common language: the international consensus on bicuspid aortic valve nomenclature and classification – Michelena- Annals of Cardiothoracic Surgery

  https://www.annalscts.com/article/view/16952/html

  It is important to recognize that a tricuspid aortic valve that is calcified or rheumatic may present a pattern of acquired (non-congenital) fusion of two cusps that may be difficult to differentiate from congenital BAV. […] The presence of a raphe has been associated with the progression of valvular dysfunction, particularly AS, and future valvular surgery. […] The two-sinus BAV type is uncommon, accounting for approximately 5-7% of BAV cases. […] The appearance of the partial-fusion BAV is that of a typical tricuspid aortic valve with three symmetrical cusps with a systolic triangular opening and commissural angles of 120, yet on surgical inspection or high-resolution imaging, less than 50% cusp fusion is noted at the base of a commissure, forming a small mini-raphe. […] The definition of aortic aneurysm is rarely applied in clinical practice, and the term aneurysm carries a somber or dismal connotation for patients. Therefore, we propose a simple, universal term: aortic dilatation. […] The importance of recognizing BAV aortopathic phenotypes is that their presence and association with specific valvular phenotypes and dysfunction patterns may imply different clinical histories for a patient with BAV.

• #1 Causes, Diagnosis, Risk Stratification and Treatment of Bicuspid Aortic Valve Disease: An Updated Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7295561/

  The most common congenital heart disease is the bicuspid aortic valve. Understanding the pathophysiology and the altered hemodynamics is a key component for the diagnosis, risk stratification and treatment. […] Together with valve replacement, transcatheter aortic valve implantation is now considered as an alternative option with good results. With this review we would like to discuss the causes, diagnostic methods, risk stratification and treatment strategies of the bicuspid aortic valve. […] Auscultatory findings include a systolic ejection click. An associated murmur of aortic stenosis (AS) may occur. Concomitant aortic insufficiency in these lesions could be present. A transthoracic echocardiography can usually confirm the diagnosis with a sensitivity of 92% and specificity of 96%. […] Sometimes a differentiation is difficult between BAV and unicuspid aortic valve, however, is especially important for preoperative evaluation. During diastole, raphe of the valve can visually make the valve appear as tricuspid. In diastole, the opening has characteristic fish morphology. In case of unsecured diagnosis transesophageal echocardiography should be performed. […] Furthermore, precise diagnosis could be performed using alternative cardiac imaging, such as magnetic resonance imaging (MRI) or computed tomography (CT), to confirm BAV anatomy, but especially for aortic imaging.

• #1 Bicuspid Aortic Valve (BAV) | Nationwide Children’s Hospital

  https://www.nationwidechildrens.org/conditions/bicuspid-aortic-valve

  A bicuspid aortic valve can be diagnosed by: […] Several treatment options are available for patients with a bicuspid aortic valve. […] Treatment is dependent on how well the valve is working and if the aortic root is enlarged. […] If symptoms increase, the valve function worsens or the first part of the aorta (aortic root) grows larger, surgery may be necessary to repair the problem. […] A bicuspid aortic valve can be diagnosed by: Echocardiogram (ultrasound pictures of the heart), Cardiac MRI (magnetic resonance imaging), Cardiac CT (computerized tomography), Electrocardiogram (EKG). […] Early identification and treatment of long-term complications are essential in keeping you healthy. This can be achieved by: Routine clinic follow-up: Physical examination may reveal increased valve problems and heart failure.

• #1 Bicuspid aortic valve: Basics and beyond | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/85/10/779

  Bicuspid aortic valve, one of the most common congenital cardiac malformations, is associated with other valvular abnormalities and aortopathies. It increases the risk of thoracic aortic aneurysm and dissection, infective endocarditis, and sudden cardiac death. Patients require regular surveillance for progressive valvular disease and aortopathy. […] Regular surveillance with transthoracic echocardiography (TTE) is required. […] Transesophageal echocardiography should be performed if TTE does not clearly show the aorta and aortic root. Magnetic resonance imaging or computed tomographic angiography may also be needed to measure the aortic root and ascending thoracic aorta. […] If initial imaging is normal and there is no aortic dilation, repeat imaging should be done every 5 to 10 years. If any abnormality is found, annual surveillance is needed.

• #1 Aortic valve disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/aortic-valve-disease/diagnosis-treatment/drc-20355122

  After testing confirms a diagnosis of aortic or other heart valve disease, your health care team may tell you the stage of disease. Staging helps determine the most appropriate treatment. […] Treatment for aortic valve disease depends on: […] If aortic valve disease is mild or moderate or if you aren’t having symptoms, you may only need regular medical checkups to watch the condition. […] Eventually, surgery or a catheter procedure may be needed to repair or replace the diseased aortic valve. Some people with aortic valve disease need surgery even if it’s not severe or when it’s not causing symptoms. […] In a mechanical valve replacement, an artificial heart valve made of strong material replaces the damaged valve. […] Transcatheter aortic valve replacement (TAVR) is a type of heart valve surgery. It’s done to replace a narrowed aortic valve, a condition called aortic valve stenosis.

• #1 Bicuspid Aortic Valve Symptoms, Diagnosis, & Treatment

  https://myheart.net/articles/bicuspid-aortic-valve/

  Operation for aortic aneurysm in patients with bicuspid aortic valve is recommended in those who have ascending aorta diameter >5.5cm. […] The newer guidelines take in to account the low risk of complications and therefore recommend surgery when aorta size is >5.5cm. […] Importantly an individualized approach should be taken and surgery recommended on an aorta size of 5.1 – 5.5 cm in patients who have shown rapid progression of aorta size (> 0.5cm per year), or in those with a family history of aortic dissection. […] Mild to moderate stenosis of the valve will not cause symptoms. What are the measurements that you are referring to? In this case i am assuming the decision to initiate surgical discussion is the size of the aorta. Bicuspid aortic valve is associated with enlargement of the aorta known as aortic aneurysm. In general patients with a bicuspid aortic valve and aortic aneurysm should undergo operation for the aneurysm if the aortic size is ≥ 55mm.

• #1 Factors Related to the Need for Surgery after the Diagnosis of Bicuspid Aortic Valve: One Center´s Experience under a Conservative Approach

  https://www.medsci.org/v10p0176.htm

  Bicuspid aortic valve (BAV) increases the risk of aortic valve dysfunction and ascending aorta aneurysm and, consequently, the need for aortic valve replacement and/or aortic repair. […] However, there is no universal consensus about the surgical criteria and the predictors for surgery. […] Aortic surgery was indicated when the ascending aorta diameter was 55 mm and was recommended based on patient characteristics and in the presence of a severe aortic valve dysfunction with an aortic diameter 50 mm. […] Multivariate Cox analysis showed that aortic stenosis (hazard ratio 4.1, p=0.001), indexed ascending aorta dilatation (hazard ratio 3.0, p=0.03) and left ventricular end-diastolic diameter 60 mm (hazard ratio=4.0, p=0.01) at diagnosis were factors associated with future surgery. […] In this setting, the presence of aortic or left ventricle dilatation and aortic stenosis at diagnosis of BAV were predictive of the need for surgery in the follow-up.

• #1 Bicuspid Aortic Valve Syndrome | Signs & Symptoms | Marfan Foundation

  https://marfan.org/conditions/bicuspid-aortic-valve/

  Bicuspid aortic valve is one of the most common congenital heart defects, appearing in 4.6 of every 1,000 live births. […] Bicuspid aortic valve can be diagnosed through medical testing, most often with an echocardiogram. Often it is not diagnosed in children because the bicuspid aortic valve can work properly for many years before any symptoms occur. It is possible that bicuspid aortic valve can be diagnosed in children with more severe cases. […] A medical professional may perform a magnetic resonance imaging test (MRI) of the heart or an ultrasound of the heart (echocardiogram) to detect a bicuspid aortic valve. A transesophageal echocardiogram may also diagnose a bicuspid aortic valve. […] Complications of bicuspid aortic valve include aortic aneurysm (bulge) and dissection (tear), which can be life-threatening, making it important for the condition to be diagnosed early and accurately. People who have been diagnosed with bicuspid aortic valve should be under the ongoing care of a heart valve disease specialist who can monitor changes in the heart, valves, and aorta over time. These changes may require surgery to replace the bicuspid valve and aortic aneurysm.

• #2 Bicuspid Aortic Valve

  https://my.clevelandclinic.org/health/diseases/16780-bicuspid-aortic-valve-disease

  A bicuspid aortic valve can cause serious complications like heart failure. […] About 1 in 3 people with a bicuspid aortic valve develop complications. They can be very serious or even fatal. Thats why people with a bicuspid aortic valve disease diagnosis need ongoing medical checkups and testing. […] Many people dont realize they have a bicuspid aortic valve until medical tests diagnose it. […] A healthcare provider may diagnose a bicuspid aortic valve with a cardiac prenatal ultrasound during pregnancy. Other times, providers diagnose it when a child has other heart problems that cause symptoms. Testing then reveals the bicuspid aortic valve. […] Your provider may run the following tests to check your heart and diagnose a bicuspid aortic valve: Echocardiogram (echo), CT scans (computed tomography scans), Heart MRI (magnetic resonance imaging).

• #2 Bicuspid Aortic Valve | Diagnosis | UK Healthcare

  https://ukhealthcare.uky.edu/gill-heart-vascular-institute/conditions/adult-congenital-heart-disease/bicuspid-aortic-valve/diagnosis

  As part of a physical exam, your primary care provider will listen to your heart with a stethoscope. They may hear a heart murmur, a potential sign of a bicuspid aortic valve. […] To investigate, your healthcare provider may order diagnostic imaging tests that allow for a closer look at the heart. […] Cardiac MRI uses magnets to create detailed images of the hearts structure and show blood flow and heart valve function. Using cardiac MRI, your physician can diagnose heart valve disease by evaluating leaky or narrowed valves.

• #2 Bicuspid Aortic Valve – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/congenital-cardiovascular-anomalies/bicuspid-aortic-valve

  Bicuspid aortic valve is the presence of only two (rather than the normal three) valve cusps. […] Diagnosis is by physical examination findings and echocardiography. Physical examination usually reveals a prominent early systolic ejection sound (click) at the apex and base of the heart. This finding is often best heard with the patient sitting; the examiner listens at the apex for a click just after the first heart sound (S1), simulating a prominent split of S1. There may be a basal systolic murmur due to aortic stenosis or a high-pitched diastolic murmur if aortic regurgitation is present. […] Echocardiography shows the characteristic finding of fusion of two of the three aortic valve leaflets. Fusion of the right coronary and left coronary leaflets is the most common morphology. Children with fusion of the right coronary and noncoronary leaflets are more likely to have progression of valve dysfunction and to require intervention during childhood.

• #2 Bicuspid Aortic Valve Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/893523-workup

  Two-dimensional echocardiography provides accurate confirmation of a bicuspid aortic valve. […] Imaging can show the bicuspid aortic valve in multiple planes. Most important information is obtained from the parasternal long-axis and short-axis views. […] Magnetic resonance imaging (MRI) is generally helpful for the diagnosis of bicuspid aortic valve and for complete assessment of the aortic root and thoracic aorta, particularly in cases of aortic root dilatation or dissection, coarctation, Turner syndrome, or Williams syndrome. Quantitative assessment of aortic valve regurgitation and left ventricular volumes are helpful in assessment of severity. […] Physical examination and if indicated, two-dimensional echocardiography are recommended as a screening tool for the offspring and first-degree relatives (especially males) of patients identified as having a bicuspid aortic valve because a high recurrence rate (as much as 12-17%) has been shown in several families.

• #2 Bicuspid aortic valve; optimal diagnosis and latest interventional treatment | mijn-bsl

  https://mijn.bsl.nl/bicuspid-aortic-valve-optimal-diagnosis-and-latest-interventiona/620314

  Bicuspid aortic valve (BAV) is one of the most common congenital heart defects with a population prevalence of 0.5 to 1.3 %. […] Patients with BAV frequently remain undiagnosed until the manifestation of symptoms. Therefore, early screening and detection of patients is warranted. Imaging of a severely stenotic aortic valve is challenging. […] From a cost-effectiveness perspective, echocardiography will still be the first choice in BAV patients. When the echocardiograms are difficult to analyse or when in doubt, CMR can be useful to come to a diagnosis. […] To summarise, to diagnose patients with BAV, echocardiography remains the first choice. However, when the echocardiograms are difficult to analyse or for careful evaluation of the progression of aortic diameters, CMR is very useful to come to a diagnosis. MSCT is increasingly being used to accurately size the aortic root diameters.

• #2 Aortic Stenosis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0301/p371.html

  Echocardiography is indicated in patients with a loud unexplained systolic murmur, a single second heart sound, a history of a bicuspid aortic valve, or symptoms that may be caused by aortic stenosis. […] Transthoracic echocardiography, the recommended initial test for patients with suspected aortic stenosis, allows reliable identification of the number of valve leaflets and assessment of valve motion, leaflet calcification, and LV function. […] The primary indices of stenosis severity are maximum transaortic velocity and the Doppler-derived mean pressure gradient. […] Patients typically remain asymptomatic until maximum transvalvular velocity is more than four times the normal velocity or at least 4.0 m per second. […] However, stenosis severity may be more difficult to assess in some patients who have only a moderately elevated transaortic velocity (3.0 to 4.0 m per second) but an aortic valve area less than 1.0 cm2. […] If concurrent LV dysfunction is detected (ejection fraction [EF] less than 50%), these patients may have clinically significant low-flow aortic stenosis.

• #2 Bicuspid Aortic Valve Causes, Symptoms, Treatments

  https://www.upmc.com/services/heart-vascular/conditions/bicuspid-aortic-valve

  Bicuspid aortic valve disease is a heart condition you’re born with. It occurs in 1-2% of people. […] A bicuspid aortic valve has two flaps, called leaflets, instead of the normal three. […] How Do You Diagnose Bicuspid Aortic Valve? […] Although people are born with a bicuspid aortic valve, it often goes undiagnosed until adulthood. […] A doctor may order further tests if they hear a heart murmur or if you are having symptoms. […] To diagnose bicuspid aortic valve or associated aortic valve disease, your doctor may order tests such as: […] Echocardiogram. An echocardiogram is a type of ultrasound your doctor may use to look for a bicuspid aortic valve. […] Transesophageal echocardiogram(TEE). A TEE is an ultrasound performed through the esophagus to get an up-close view of the heart valve.

• #2 Bicuspid Aortic Valve Symptoms, Diagnosis, & Treatment

  https://myheart.net/articles/bicuspid-aortic-valve/

  An ultrasound scan of the heart known as echocardiography is typically used to diagnose bicuspid aortic valve. This will allow assessment of the valve structure, and look for associated valve tightening (aortic stenosis) or leakiness (aortic regurgitation). Importantly this will also allow assessment of the aorta and to assess widening of the aorta in the chest (aortic aneurysm). […] Sometimes standard echocardiography isn’t able to accurately assess the valve and so it can be difficult to differentiate between a normal tricuspid, and a bicuspid valve. Transesophageal echocardiography is much more accurate, however that involves passing a small camera in to the stomach to take close pictures of the heart and is therefore not done routinely. […] Therefore CT or MRI imaging is recommended in those patients who do not have adequate echo pictures. MRI is generally preferred as it avoids the need for radiation exposure; particularly in those who need repeated follow up studies for surveillance.

• #2 Diagnosis and Outcomes of Transcatheter Aortic Valve Implantation in Bicuspid Aortic Valve Stenosis | ICR Journal

  https://www.icrjournal.com/articles/diagnosis-and-outcomes-transcatheter-aortic-valve-implantation-bicuspid-aortic-valve

  Bicuspid aortic valve is the most common congenital cardiac malformation. […] Recently, the diagnosis and classification of bicuspid aortic valve based on multidetector computed tomography (MDCT) assessment has been proposed, which may have an impact of outcomes after TAVI. […] This review article describes the advancements in diagnosis and outcomes of bicuspid AS. […] Pre-procedural MDCT assessment of aortic valve has become standardised in the TAVI era, and pre-procedural diagnosis of bicuspid AS with MDCT has gained considerable attention. […] With accumulation of experience in MDCT assessments of aortic valves, the great variety of bicuspid AS morphology has been observed, leading Jilaihawi et al. to propose a more simplified, TAVI-directed classification of bicuspid aortic valve.

• #2 Diagnosis and Outcomes of Transcatheter Aortic Valve Implantation in Bicuspid Aortic Valve Stenosis | ICR Journal

  https://www.icrjournal.com/articles/diagnosis-and-outcomes-transcatheter-aortic-valve-implantation-bicuspid-aortic-valve

  This classification may clarify the difference between functional/acquired bicuspid aortic valves and bicuspid aortic valves with one raphe (Sievers type 1) on the basis of MDCT images. […] Given that bicuspid AS is associated with procedural challenges, the proper identification and classification of bicuspid AS phenotypes is essential. […] TAVI has led to changes in the diagnosis and classification of bicuspid aortic valve.

• #2 Bicuspid aortic valve : MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/007325.htm

  A bicuspid aortic valve (BAV) is an aortic valve that only has two leaflets, instead of three. […] During an exam, your health care provider may find signs of a BAV including: Enlarged heart, Heart murmur, Weak pulse in the wrists and ankles. […] Tests that may be ordered include: MRI, which provides a detailed image of the heart, Echocardiogram, which is an ultrasound that views the heart structures and blood flow inside the heart. […] If your provider suspects complications or additional heart defects, other tests may include: Chest x-ray, which produces an image of the heart and large arteries, Electrocardiogram (ECG), which measures the electrical activity of the heart, Cardiac catheterization, a procedure in which a thin tube (catheter) is placed into the heart to see blood flow and take accurate measurements of blood pressure and oxygen levels, MRA, an MRI that uses a dye to view the blood vessels of the heart.

• #2 Clinical manifestations and diagnosis of bicuspid aortic valve in adults – UpToDate

  https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-bicuspid-aortic-valve-in-adults

  Leaflet orientation may affect valve function with fusion of the right and noncoronary leaflet associated with greater valvular dysfunction. Leaflet orientation may also predict the pattern of aortopathy and is associated with differential regional aortic wall stress. Calcification of the bicuspid aortic valve increases with age and occurs more rapidly than that seen with tricuspid aortic valve. There is abnormal leaflet motion and turbulence during the cardiac cycle in bicuspid aortic valves and this may play a role in premature degeneration.

• #2 :: JKSR :: Journal of the Korean Society of Radiology

  https://jksronline.org/DOIx.php?id=10.3348/jksr.2022.0170

  This study aimed to compare the diagnostic performance of cardiac CT and transthoracic echocardiogram (TTE) depending on the degree of valvular calcification and bicuspid aortic valve (BAV) subtype. […] The diagnostic accuracy of cardiac CT and TTE was calculated using a reference standard for intraoperative inspection. […] CT demonstrated significantly higher sensitivity, negative predictive value, and accuracy than TTE in detecting BAV. […] Cardiac CT had a higher diagnostic performance in detecting BAV than TTE and may help diagnose BAV, particularly in patients with severe valvular calcification. […] According to the 2020 ACC/AHC guidelines for the management of valvular heart disease, transthoracic echocardiogram (TTE) is the first imaging tool used to evaluate aortic valve anatomy in patients with BAV.

• #2 Bicuspid Aortic Valve Symptoms, Diagnosis, & Treatment

  https://myheart.net/articles/bicuspid-aortic-valve/

  About 20-30% of patients with bicuspid aortic valve will have other family members affected. There is no exact genetic cause known, and the inheritance pattern can be very variable although there certainly appears to be a genetic component. In patients with bicuspid aortic valve with a known family history of valve disease or aortic disease, it is definitely recommended to screen all first-degree relatives with echocardiography. Most experts would recommend that echocardiographic screening be performed in all first-degree relatives of patients with bicuspid aortic valve. […] The bicuspid aortic valve is a valvulo-aortopathy diagnosis, which means it affects the valve and the aorta. If the valve becomes severely leaky or severely tight, then operation is performed as per usual guidelines. These are basically if symptoms develop, or there is evidence of heart failure or heart muscle dysfunction. However many patients with bicuspid aortic valve will have aortic disease without significant valve disease and may need to undergo operation of the aorta aneurysm. Some patients will require both are done.

• #2 Bicuspid Aortic Valve (BAV) | Nationwide Children’s Hospital

  https://www.nationwidechildrens.org/conditions/bicuspid-aortic-valve

  Cardiac imaging studies: Echocardiogram, cardiac MRI or cardiac CT may be used to identify aortic aneurysm, aortic root enlargement, and to evaluate the left ventricle. […] Be aware of cardiac symptoms: Seek medical attention for chest or back pain, racing or skipping heart beats, shortness of breath, or persistent unexplained fevers.

• #2 Bicuspid aortic valve: Basics and beyond | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/85/10/779

  Echocardiographic evaluation of valvular function, ventricular dimensions and function, and diameter of the aortic root and ascending aorta should be performed in every patient with bicuspid aortic valve. If initial imaging is normal and there is no aortic dilation, imaging should be repeated every 5 to 10 years. If any abnormality is found, repeat imaging is needed every year. […] Magnetic resonance imaging (MRI) or computed tomographic (CT) angiography may be required to better assess the aorta for patients requiring a surgical intervention, or when aortic dimensions are not clearly visualized on TTE.

• #2 Bicuspid Aortic Valve Symptoms, Diagnosis, & Treatment

  https://myheart.net/articles/bicuspid-aortic-valve/

  In patients already requiring surgery on the aortic valve for severe aortic valve disease, lower thresholds for aortic surgery may be used, such as 45mm. Decisions are regarding the need for and the type of operation should be made on a case by case basis by a specialist team and take all these factors in to account.

• #2 Aortic valve disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/aortic-valve-disease/diagnosis-treatment/drc-20355122

  Aortic valve replacement typically requires open-heart surgery. Sometimes, surgeons can use a minimally invasive procedure called transcatheter aortic valve replacement (TAVR) to replace a narrowed aortic valve with a biological tissue valve. TAVR uses smaller incisions than those used in open-heart surgery. […] If you think you have aortic valve disease, make an appointment for a health checkup.

• #2 Factors Related to the Need for Surgery after the Diagnosis of Bicuspid Aortic Valve: One Center´s Experience under a Conservative Approach

  https://www.medsci.org/v10p0176.htm

  The presence of aortic stenosis or ascending aorta dilatation at diagnosis of BAV, as well as a left ventricular end-diastolic diameter 60 mm, predicted the need for surgery (aortic stenosis Hazard Ratio=4.1, p=0.001; ascending aorta dilatation Hazard Ratio=3.0, p=0.03; left ventricular end-diastolic diameter 60 mm Hazard Ratio=4.0, p=0.01). […] A relatively conservative approach for the indication of ascending aortic surgery in BAV is safe.

• #2 Bicuspid Aortic Valve (BAV) Treatment | Lurie Children’s

  https://www.luriechildrens.org/en/specialties-conditions/bicuspid-aortic-valve-program/

  BAV is the most common form of congenital heart disease, affecting between 1-2% of the general population. […] Screening is recommended for all first-degree relatives (such as parents and siblings) of a person diagnosed with BAV. Early diagnosis can lead to the proper surveillance, management and improved long-term outcomes. […] The easiest way to detect BAV and check for disease progression is with an ultrasound of the heart, called an echocardiogram. […] If more information is needed, we offer additional cardiac imaging techniques, such as computerized tomography (CT) and magnetic resonance imaging (MRI). […] Management of the patient with BAV includes: Education, Good dental care and endocarditis prophylaxis, if indicated, Serial clinical, echocardiographic and CT/MRI follow up, Treatment of high blood pressure and possible medical therapy for associated aortic valve dysfunction and/or aortic dilation, Potential physical activity restrictions, Cardiac transcatheter interventions and/or surgery for significant aortic stenosis and/or regurgitation, Surgery for aortic root aneurysm to prevent life-threatening rupture, Surgery for aortic valve replacement. […] Bicuspid aortic valve (BAV) screening is recommended for all first-degree relatives of someone with BAV. Early diagnosis can prevent later complications.

• #2 Bicuspid Aortic Valve

  https://my.clevelandclinic.org/health/diseases/16780-bicuspid-aortic-valve-disease

  Medications like beta-blockers or diuretics can help with symptoms. But they wont fix this condition. Bicuspid aortic valve disease treatment involves surgery for about 4 out of 5 people with this problem. […] Its important to have surgery early enough to prevent permanent damage to your heart. […] If you have a bicuspid aortic valve diagnosis, talk with your provider about the condition of your heart and whether you need treatment.

• #3 Bicuspid Aortic Valve Syndrome | Signs & Symptoms | Marfan Foundation

  https://marfan.org/conditions/bicuspid-aortic-valve/

  Bicuspid aortic valve is one of the most common congenital heart defects, appearing in 4.6 of every 1,000 live births. […] Bicuspid aortic valve can be diagnosed through medical testing, most often with an echocardiogram. Often it is not diagnosed in children because the bicuspid aortic valve can work properly for many years before any symptoms occur. It is possible that bicuspid aortic valve can be diagnosed in children with more severe cases. […] A medical professional may perform a magnetic resonance imaging test (MRI) of the heart or an ultrasound of the heart (echocardiogram) to detect a bicuspid aortic valve. A transesophageal echocardiogram may also diagnose a bicuspid aortic valve. […] Complications of bicuspid aortic valve include aortic aneurysm (bulge) and dissection (tear), which can be life-threatening, making it important for the condition to be diagnosed early and accurately. People who have been diagnosed with bicuspid aortic valve should be under the ongoing care of a heart valve disease specialist who can monitor changes in the heart, valves, and aorta over time. These changes may require surgery to replace the bicuspid valve and aortic aneurysm.

• #3 :: JKSR :: Journal of the Korean Society of Radiology

  https://jksronline.org/DOIx.php?id=10.3348/jksr.2022.0170

  In previous studies, cardiac CT was shown to be more accurate than TTE in differentiating BAV and TAV. […] Therefore, we sought to compare the diagnostic accuracies of cardiac CT and TTE based on valve morphology confirmed through intraoperative inspection. […] For the detection of BAV, sensitivity, specificity, PPV, and NPV were 0.96, 0.95, 0.93, and 0.97 in CT and 0.77, 0.97, 0.94, and 0.87 in TTE, respectively. […] The diagnostic accuracy was 0.95 in CT and 0.89 in TTE. […] The TTE error rate for BAV diagnosis was higher in the fused subtype. […] In conclusion, CT may be a more useful modality than TTE in detecting BAV, particularly in patients with severe valvular calcification and fused-type BAV.

• #3 Bicuspid Aortic Valve: Diagnosis, Treatment, and Outlook

  https://www.healthline.com/health/heart-disease/bicuspid-aortic-valve

  Depending on the severity of your bicuspid aortic valve, treatment options range from regular appointments with your cardiologist to valve repair or replacement surgery. […] When symptoms are present, you may need to replace or repair the valve. […] If aortic stenosis has developed, the valve may have to be replaced. […] If aortic regurgitation is the problem, valve repair may be possible, often with a catheter.

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