Materiały źródłowe

• #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. […] 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. […] Women with a bicuspid aortic valve who are contemplating pregnancy should undergo echocardiography first, and some may need to undergo surgery. […] Because complications may be life-threatening, early detection of progressive disease by regular screening is critical. 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.

• #2 Bicuspid Aortic Valve: What Causes It and Its Symptoms

  https://www.bajajallianz.com/blog/wellness/bicuspid-aortic-valve-symptoms-and-causes.html

  While bicuspid aortic valve disease cannot be prevented since it is congenital, early detection and management can help prevent complications. […] Regular medical check-ups, especially for those with a family history of heart defects, are essential. […] Maintaining a heart-healthy lifestyle, including regular exercise, a balanced diet, and avoiding smoking, can help manage the condition and reduce the risk of complications. […] No, BAV is congenital and cannot be prevented. However, early detection and management can prevent complications.

• #3 Infective endocarditis risk in patients with bicuspid aortic valve: Systematic review and meta-analysis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10400861/

  Antibiotic prophylaxis in bicuspid aortic valve patients is currently a matter of debate. Although it is no longer recommended by international guidelines, some studies indicate a high risk of infective endocarditis. […] Bicuspid aortic valve (BAV) patients are considered of intermediate risk for infective endocarditis and antibiotic prophylaxis is not indicated. […] Recent studies, most of them of retrospective nature, have been published, but the results continue to be unclear regarding the true incidence and risk magnitude of infective endocarditis in BAV patients. […] This systematic review and meta-analysis suggests that bicuspid aortic valve patients have a significant high risk of native valve infective endocarditis. Large prospective high-quality studies are required to estimate more accurately the incidence of infective endocarditis, the relative risk and the potential benefit of antibiotic prophylaxis.

• #4 Bicuspid Aortic Valve Endocarditis Caused by Streptococcus sanguinis: A Case Report

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10870037/

  Antibiotic prophylaxis prior to dental work in bicuspid aortic valve (BAV) patients is currently a matter of debate. […] BAV patients are at high risk of IE, emphasizing the need for prophylactic antibiotics in dental cleaning as well as invasive dental procedures in those with BAV. […] A systematic review published in July 2023 found that BAV patients are at 12-fold higher risk compared to patients with tricuspid aortic valve (TAV). […] This case signifies that even routine dental cleaning can be the source of life-threatening infection. […] Our patients outcome with his dental cleaning combined with the data from the systematic review suggest that BAV patients are at high risk of IE, emphasizing the need for prophylactic antibiotics in routine dental cleaning as well as more invasive dental procedures in those with BAV. […] The present case of S. sanguinis endocarditis in a 63-year-old male with BAV with literature review that shows that BAV patients are at higher risk compared to patients with tricuspid aortic valve emphasizes the need for prophylactic antibiotics prior to dental work in those with BAV.

• #5 Infective endocarditis risk in patients with bicuspid aortic valve: Systematic review and meta-analysis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10400861/

  The main finding of this systematic review is that the included BAV patients had a significant high risk of native valve infective endocarditis during follow up, being 12-fold higher than general population after adjusted estimates, with an estimated incidence of 48 per 10,000 patients per year. […] This study indicates that the incidence-rate of infective endocarditis in this population is higher than the one previously reported in patients with moderate risk, therefore, general measures to prevent infective endocarditis, such as good oral hygiene, should be reinforced in these patients. The use of antibiotic prophylaxis is still doubtful but may be considered in the presence of other risk factors for infective endocarditis. […] BAV patients have a significant risk of infective endocarditis, higher than patients at moderate risk and closer to the previously reported in high-risk patients. Large prospective high-quality studies are required to estimate more accurately the incidence of infective endocarditis, the relative risk, and the potential benefit of antibiotic prophylaxis.

• #6 Bicuspid Aortic Valve Medication

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

  Patients with bicuspid aortic valve are at increased risk for infective endocarditis. Prophylactic antibiotics are no longer required for dental or surgical procedures as recommended by the American Heart Association in 2007 but are recommended to prevent recurrence if an episode of endocarditis has occurred, prosthetic heart valve placed or for 6-months after complete repair of congenital heart defects. […] [Guideline] Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. 2007 Oct 9. 116(15):1736-54. […] [Guideline] Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the American Heart Association. Circulation. 2015 Oct 13. 132(15):1435-86.

• #7 Bicuspid Aortic Valve Treatment & Management: Medical Care, Surgical Care, Diet

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

  No specific medical care is required for individuals with bicuspid aortic valve unless they have progressive deterioration or infection. […] Serial follow-up evaluations are important for early recognition of potential complications (valve regurgitation, valve stenosis, progressive aortic root dilation) and the prevention of possible bacterial endocarditis by emphasizing importance of maintaining good oral and dental hygiene with regular dental visits (two times each year). […] Endocarditis prophylaxis is not indicated unless there is prior history of endocarditis, prosthetic valve replacement has been performed or within 6-months from heart surgery complete repair of aortic valvar or other associated congenital heart conditions. […] The patient with simple, uncomplicated bicuspid aortic valve should not require special anesthetic precautions, other than bacterial endocarditis prophylaxis, when appropriate (see Medical Care).

• #7 Bicuspid Aortic Valve Treatment & Management: Medical Care, Surgical Care, Diet

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

  Because hypercholesterolemia and other coronary artery disease risk factors may accelerate the sclerosis and deterioration of a congenitally bicuspid aortic valve, a heart-healthy diet is recommended for all patients, not only those with recognized risk factors. […] Patients who develop valve regurgitation or stenosis from a congenitally bicuspid aortic valve may require restrictions from strenuous competitive sports. […] Patients with aortic valve regurgitation should avoid strenuous isometric activity, such as weight lifting, rope climbing, and pull-ups.

• #8 Infective Endocarditis in Bicuspid Aortic Valve or Mitral Valve Prolapse Patients

  https://www.acc.org/latest-in-cardiology/journal-scans/2018/06/11/15/42/infective-endocarditis-in-patients-with-bicuspid-aortic-valve-or-mvp

  BAV and MVP patients had a higher incidence of viridans group streptococci IE than did the high-risk and low/moderate-risk group patients (35.2% and 39.3% vs. 12.1% and 15.0%, respectively; all p […] Compared to other patients with IE, IE among patients with BAV and MVP more often was associated with viridans group streptococci and IE from suspected odontologic origin, and complications were similar to those among high-risk IE patients. The authors concluded that these findings suggest that BAV and MVP should be classified as high-risk IE conditions, and the use of IE antibiotic prophylaxis should be reconsidered. […] Current guidelines recommend the use of antibiotic prophylaxis to reduce the risk of IE only among patients thought to be at especially high risk of adverse outcomes associated with IE, and notably do not include patients with known BAV or MVP. However, debate regarding the guideline recommendations continues. Supporting a more restrictive use of IE prophylaxis are data suggesting that, even if overall rates of IE are increasing, culprit microorganisms often are Staphylococcal species that would not be affected by typical antibiotic prophylaxis regimens. However, data from this large multicenter registry suggest that, among patients with known native heart valve diseases of BAV or MVP, viridans group streptococci (which would be affected by antibiotic prophylaxis) play an important role. Further, this study offers data suggesting that patients with BAV or MVP are at high risk of adverse clinical outcomes. In the absence of prospective randomized data, there remains a rationale to discuss antibiotic prophylaxis for IE risk reduction with patients with significant native heart valve disease, including BAV or MVP.

• #9 Infective Endocarditis Prophylaxis May Benefit Bicuspid Aortic Valve, Mitral Valve Prolapse – The Cardiology Advisor

  https://www.thecardiologyadvisor.com/news/infective-endocarditis-prophylaxis-may-benefit-bicuspid-aortic-valve-mitral-valve-prolapse/

  Infective endocarditis in patients with concurrent bicuspid aortic valve or mitral valve prolapse was associated with higher rates of viridans group streptococci and had a clinical course similar to that of high-risk patients, according to a recent study published in the Journal of the American College of Cardiology. […] Overall, our findings open the debate to consider infective endocarditis antibiotic prophylaxis before dental procedures not only in high-risk cardiac conditions, but also in patients with bicuspid aortic valve and mitral valve prolapse.

• #10 British Heart Valve Society update: a change in the NICE guidelines on antibiotic prophylaxis – The British Journal of Cardiology

  https://bjcardio.co.uk/2016/08/british-heart-valve-society-update-a-change-in-the-nice-guidelines-on-antibiotic-prophylaxis/

  The National Institute for Health and Care Excellence (NICE) has made an important change to Clinical Guideline 64 (CG64) adding the word routinely to Recommendation 1.1.3: Antibiotic prophylaxis against infective endocarditis is not recommended routinely for people undergoing dental procedures. In a letter about the change, Sir Andrew Dillon, CEO of NICE, confirmed that in individual cases, antibiotic prophylaxis may be appropriate. […] Prophylaxis should be with amoxicillin 3 g by mouth one hour before the procedure or, for patients with penicillin hypersensitivity, clindamicin 600 mg orally. Adverse effects from oral amoxicillin prophylaxis are uncommon with no deaths reported in Europe since records began. Clindamicin has a slightly higher level of risk. Both are cost-effective in high-risk patients having high-risk dental procedures.

• #10 British Heart Valve Society update: a change in the NICE guidelines on antibiotic prophylaxis – The British Journal of Cardiology

  https://bjcardio.co.uk/2016/08/british-heart-valve-society-update-a-change-in-the-nice-guidelines-on-antibiotic-prophylaxis/

  Staff in general practices and specialist valve clinics should emphasise that good oral hygiene and regular dental review are as important as antibiotic prophylaxis, if not more so, in reducing the risk of IE. The European Society of Cardiology (ESC) recommend strict dental and cutaneous hygiene with regular dental surveillance. It is also important to educate patients at risk in recognising the possibility of IE. Typically, there may be persistent night sweats, general malaise and weight loss. At least two sets of blood cultures should be taken before starting antibiotics. […] Antibiotic prophylaxis: indicated for people at high risk having high-risk dental procedures. Record details of consent process in the dental notes. Use amoxicillin 3 g or clindamicin 600 mg orally one hour before.

• #11 Prevention of aortic valve disease: between doubts and certainties

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-18/prevention-of-aortic-valve-disease-between-doubts-and-certainties

  The objective of primary prevention is the proper identification and adequate antibiotic treatment of group A beta-haemolytic streptococcal tonsillopharyngitis. […] Endocarditis prophylaxis is based on antibiotic treatment, in specific patients, when a high-risk procedure is performed. […] Prevention measures are based on good daily dental hygiene, using optimal quality toothbrushes, and dental follow-up. […] Prevention of aortic valve disease still requires research studies to define the correct approach.

• #12

  https://www.sgh.com.sg/patient-care/conditions-treatments/bicuspid-aortic-valve

  Antibiotic for dental prophylaxis is no longer required for patient with bicuspid aortic valve. […] Therefore it is important for congenital patient to maintain good oral, dental and skin hygiene as primary prevention. […] Antibiotic prophylaxis is considered for patient at highest risk for IE before surgery and dental procedures. Please discuss with your congenital team for the latest update on the antibiotic prophylaxis.

• #13 Bicuspid Aortic Valve: Health Recommendations and What to Avoid

  https://www.healthline.com/health/heart-health/bicuspid-aortic-valve-what-to-avoid

  Gum disease (periodontitis) can be hazardous for your heart valves. A 2017 study suggests that thorough periodontal treatment may be necessary to help avoid complications associated with heart valve surgery. […] Heart health depends on keeping up with doctor appointments and health screenings. You may need periodic imaging of your heart, such as echocardiography, to look for any changes in the shape, size, and function of your aortic valve and the rest of your heart. […] Physical activity on all or most days of the week, provided your regimen is approved by your doctor or a cardiac rehabilitation specialist, supports healthy heart function and also contributes to better weight management and blood pressure control. […] Smoking is one of the most important activities you should avoid if you have a bicuspid aortic valve. The chemicals in cigarette smoke can harm the valves and blood vessels in the heart, potentially speeding up the progression of heart valve disease or other cardiac complications.

• #13 Bicuspid Aortic Valve: Health Recommendations and What to Avoid

  https://www.healthline.com/health/heart-health/bicuspid-aortic-valve-what-to-avoid

  A bicuspid aortic valve may present few problems throughout your life. But you’ll still need to live a heart-healthy lifestyle and monitor your cardiovascular system to prevent complications. […] While many people can live healthy lives with a bicuspid aortic valve, it’s important to follow your doctor’s recommendations and commit to a heart-healthy lifestyle. Because a bicuspid aortic valve raises the risk of valve problems later in life, monitoring your heart and recognizing signs of valve disease is equally important. […] Adopting behaviors that support optimal cardiovascular health is the best thing you can do for your heart and your health if you have a bicuspid aortic valve. […] A balanced diet, such as a Mediterranean-style eating plan or the Dietary Approaches to Stop Hypertension (DASH) diet, contributes to weight management and lower blood pressure, blood sugar, and cholesterol.

• #13 Bicuspid Aortic Valve: Health Recommendations and What to Avoid

  https://www.healthline.com/health/heart-health/bicuspid-aortic-valve-what-to-avoid

  Medications can’t cure bicuspid aortic valve or prevent it from progressing to another condition, such as aortic valve regurgitation or aortic valve stenosis. […] A bicuspid aortic valve can lead to aortic valve regurgitation or aortic valve stenosis. It’s important to pay close attention to signs that your bicuspid aortic valve needs a medical evaluation. […] A bicuspid aortic valve is likely to progress to a potentially severe problem such as aortic valve stenosis or aortic valve regurgitation. These conditions can often be managed with medications, procedures, or both, to repair the valve. […] Even these individuals need to live a heart-healthy lifestyle and monitor the function and health of their aortic valve and their cardiovascular system to prevent any severe complications down the road.

• #14 Should More Patients with Heart Valve Disease Take Antibiotics Before Dental Procedures?

  https://consultqd.clevelandclinic.org/should-more-patients-with-heart-valve-disease-take-antibiotics-before-dental-procedures

  Currently, antibiotic prophylaxis against infective endocarditis (IE) is generally not recommended under practice guidelines for patients with a bicuspid aortic valve (BAV) or mitral valve prolapse (MVP) who are undergoing a dental procedure. […] An accompanying editorial asks whether its time to widen the net and provide antibiotic coverage before dental procedures for patients with these valve conditions. […] The justification was that bacteria introduced into the bloodstream through the gums predisposed patients with abnormal valves to accumulate bacterial growth on the sticky valve surfaces and develop IE. […] We still ask patients for dental clearance before valve surgeries and emphasize to patients that dental hygiene is critical to avoid gingivitis, he says. Seeing a dentist regularly is probably more important for our patients than using antibiotics before every dental visit. […] For patients who have other reasons for increased risk, antibiotic prophylaxis may be justifiable.

• #15 Bicuspid aortic valve: What to avoid

  https://www.medicalnewstoday.com/articles/bicuspid-aortic-valve-what-to-avoid

  A person with a bicuspid aortic valve can support their heart health by maintaining a nutritious diet, getting enough appropriate exercise, and taking steps to manage their condition. […] A person can help manage a bicuspid aortic valve by maintaining heart-healthy lifestyle habits and receiving medical treatment. […] There is currently no medical treatment that can prevent or slow the progression of BAV into aortic stenosis or aortic regurgitation. […] A person with BAV needs to limit or avoid: […] Individuals with BAV need to get regular, moderate-intensity exercise. However, they also need to avoid strenuous activity that could cause further heart strain. […] A person with BAV should contact a doctor if their symptoms progress. […] People with BAV can typically live full, healthy lives with appropriate medical treatment and a heart-healthy lifestyle.

• #15 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. […] 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. […] Women with a bicuspid aortic valve who are contemplating pregnancy should undergo echocardiography first, and some may need to undergo surgery. […] Because complications may be life-threatening, early detection of progressive disease by regular screening is critical. 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.

• #16 Living with Bicuspid Aortic Valve | Lurie Children’s

  https://www.luriechildrens.org/en/blog/caring-for-patients-with-bicuspid-aortic-valve/

  The most important thing that patients with BAV can do is to lead a healthy lifestyle which includes a heart-healthy diet and routine exercise! Exercise is beneficial to both the physical and emotional well-being of people with BAV disease, and regular exercise is an important life-long general wellness recommendation. Most people with BAV can safely exercise without significant restrictions. Strenuous isometric exercise (e.g., weight-lifting, climbing steep inclines, chin-ups), should be avoided if there is severe valve disease, or moderate to severe aortic ectasia. […] Good dental care and endocarditis prophylaxis, if indicated […] Patients with bicuspid aortic valve should have regular follow up with their cardiologist to monitor valve dysfunction and aortopathy.

• #17 Prevention

  http://www.cardiosmart.org/topics/aortic-stenosis/prevention

  There are steps you can take to strengthen your heart and guard against developing aortic stenosis. These include: […] Although not proved, factors that can cause calcium buildup in the arteries of the heart (called atherosclerosis) also can cause calcium buildup on the aortic valve. […] If you have high blood pressure, high cholesterol, diabetes, or kidney problems, you should speak to your doctor to get these conditions treated. […] Infection in your gums can sometimes cause an infection of the heart valves and cause aortic stenosis. […] The bacteria that cause strep throat can sometimes cause rheumatic fever if left untreated. […] If rheumatic fever is not treated, it can cause aortic stenosis years later.

• #18 Can Aortic Stenosis Be Prevented? | Cardiovascular Disease Specialists located in Riverside, CA | Syed Bokhari, MD, FACC

  https://www.acvcare.com/post/can-aortic-stenosis-be-prevented

  Preventing aortic stenosis is an area actively being studied, but we know that specific health problems increase your risk for aortic valve narrowing. Eliminating your risk factors influences the health of your aortic valve. […] Since aortic stenosis develops over decades, you’ll need to follow lifelong habits that protect your overall health and prevent chronic diseases, especially those that contribute to aortic stenosis. […] High blood pressure (hypertension) increases your risk of aortic stenosis. In fact, of all the known risk factors, it has the most significant influence. […] It’s also estimated that 40% of patients diagnosed with aortic stenosis have hypertension, which increases the amount of stress on your heart as it works to pump blood. Additional stress may speed up the progression of aortic stenosis and its complications, such as heart failure.

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

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

  Close relatives should be evaluated for aortic valve and thoracic aortic disease. […] The American College of Cardiology (ACC) and the American Heart Association (AHA), backed by radiologic and cardiovascular associations, concur in recommending echocardiographic screening and routine screening of the thoracic aorta for aortic root dilation in first-degree relatives (ie, siblings, parents, and children) of patients with bicuspid aortic valve (class I recommendation). […] The 2015 ACC/AHA guidelines for competitive athletes with cardiovascular abnormalities recommend annual screening with TTE or MRI angiography for athletes with bicuspid aortic valve and coexisting dilation of the ascending aorta (aortic diameter 4042 mm in men and 3639 mm in women) (class I recommendation, level of evidence C). […] Patients with bicuspid aortic valve and aortic root enlargement of more than 40 mm should have preconception counseling about surgery for aortic root replacement before becoming pregnant.

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

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

  Bicuspid aortic valve may be an inherited condition, occurring in up to 9% of first-degree relatives. Recent studies have shown that first-degree relatives may also have aortic enlargement in the absence of a BAV. 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. […] Management of the patient with BAV includes: […] Good dental care and endocarditis prophylaxis, if indicated. […] Bicuspid aortic valve (BAV) screening is recommended for all first-degree relatives of someone with BAV. Early diagnosis can prevent later complications.

• #21 Aortic valve stenosis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/aortic-stenosis/symptoms-causes/syc-20353139

  Some possible ways to prevent aortic valve stenosis are: […] Get a health checkup when you have a sore throat. Strep throat that is not treated can lead to rheumatic fever, which can damage heart valves. Strep throat can usually be easily treated with antibiotics. Rheumatic fever is more common in children and young adults. […] Keep the heart healthy. Talk about your risk factors for heart disease with your healthcare team. Ask how to prevent and manage them. Risk factors such as high blood pressure, obesity and high cholesterol may be linked to aortic valve stenosis. […] Take care of the teeth and gums. There may be a link between infected gums, called gingivitis, and a heart infection known as endocarditis. Endocarditis is a risk factor for aortic valve stenosis.

• #22 Bicuspid Aortic Valve – Causes, Symptoms, Complications, Diagnosis, Treatment, Prevention & Precautions

  https://www.medindia.net/health/conditions/bicuspid-aortic-valve.htm

  There is no known way to prevent bicuspid aortic valve. If bicuspid aortic valve runs in the family, the healthcare provider must be consulted before planning a pregnancy. […] Patients suffering from bicuspid aortic valves are advised preventive antibiotics before any invasive procedure, to prevent the development of infective endocarditis. […] Beta-blocker medicines reduce progression of aortic aneurysms. […] Blood pressure must be closely monitored and hypertension must be avoided. […] Statin medication to reduce cholesterol levels and prevent calcium build-up on aortic valve and reduce risk of aortic stenosis.

• #23

  https://www.nhcs.com.sg/patient-care/conditions-treatments/bicuspid-aortic-valve

  Antibiotic for dental prophylaxis is no longer required for patient with bicuspid aortic valve. […] The incident of IE in congenital patient is higher than general population. Therefore it is important for congenital patient to maintain good oral, dental and skin hygiene as primary prevention. […] Antibiotic prophylaxis is considered for patient at highest risk for IE before surgery and dental procedures. Please discuss with your congenital team for the latest update on the antibiotic prophylaxis.

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