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Szöcs K, Toprak B, Schön G, Rybczynski M, Brinken T, Mahlmann A, Girdauskas E, Blankenberg S, von Kodolitsch Y. Concomitant cardiovascular malformations in isolated bicuspid aortic valve disease: a retrospective cross-sectional study and meta-analysis. Cardiovasc Diagn Ther 2022; 12:400-414. [PMID: 36033227 PMCID: PMC9412207 DOI: 10.21037/cdt-22-112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/21/2022] [Indexed: 11/22/2022]
Abstract
Background Congenital bicuspid aortic valve affects up to 2% of the general population. It occurs in complex congenital heart defects or in syndromes such as Turner, Marfan, or Loeys-Dietz. However, the majority of bicuspid aortic valves are considered to manifest as isolated malformations. Methods We aimed to assess retrospectively associated cardiovascular malformations in 200 individuals with bicuspid aortic valve considered to occur as an isolated manifestation. All individuals underwent transthoracic echocardiography, 164 thoracoabdominal tomographic imaging, and 84 coronary artery imaging. In addition, we also performed a meta-analysis of data from the literature to assess the occurrence of associate malformations. Results In our retrospective cross-sectional study collective, the mean age was 45±15 years, 154 (77%) individuals were male. Anatomy of bicuspid aortic valve according to Schaefer was type 1 in 142 (71%), type 2 in 35 (18%), type 3 in 2 (1%), unicuspid in 6 (3%), and unclassified in 15 (8%) individuals. Coarctation of the aorta had 4.2% of individuals, 3.6% had coronary anomalies. No individual had a patent ductus arteriosus, 0.5% had atrial and ventricular septal defect each, 1.5% mitral valve prolapse. No individual had a tricuspid valve prolapse. Our meta-analysis identified in cohorts with isolated bicuspid aortic valve 11.8% (95% CI: 7.7–16.0%) individuals with aortic coarctation, 3.7% (95% CI: 1.2–6.1%) with coronary anomalies, 3.3% (95% CI: 0.0–6.7%) with patent ductus arteriosus, 5.9% (95% CI: 1.3–10.5%) with ventricular septal defect and 1.6% (95% CI: 1.1–2.1%) with mitral valve prolapse. Conclusions Individuals with isolated bicuspid aortic valve may exhibit a variety of associated cardiovascular malformations and therefore screening for associated malformations may be warranted.
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Affiliation(s)
- Katalin Szöcs
- German Aortic Center Hamburg at University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Betül Toprak
- German Aortic Center Hamburg at University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Gerhard Schön
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Meike Rybczynski
- German Aortic Center Hamburg at University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tatjana Brinken
- German Aortic Center Hamburg at University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Adrian Mahlmann
- University Centre for Vascular Medicine and Division of Angiology, Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Center for Vascular Medicine, Clinic for Angiology, St. Josefs-Hospital, Katholisches Krankenhaus Hagen gem. GmbH, Hagen, Germany
| | - Evaldas Girdauskas
- German Aortic Center Hamburg at University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Blankenberg
- German Aortic Center Hamburg at University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Yskert von Kodolitsch
- German Aortic Center Hamburg at University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Lee CH, Inohara T, Hayashida K, Park DW. Transcatheter Aortic Valve Replacement in Asia: Present Status and Future Perspectives. JACC. ASIA 2021; 1:279-293. [PMID: 36341218 PMCID: PMC9627874 DOI: 10.1016/j.jacasi.2021.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/01/2021] [Accepted: 10/07/2021] [Indexed: 05/28/2023]
Abstract
Over the last decade, based on evidence from multiple randomized clinical trials, transcatheter aortic valve replacement (TAVR) has become the established treatment for patients with symptomatic severe aortic stenosis. Despite the overwhelming expansion of TAVR in Western countries, the initial uptake and widespread adoption of this procedure have been relatively delayed in Asian countries, owing to the high cost of devices; limited local health and reimbursement policies; and lack of specific training/proctoring program, specialized heart team, or dedicated infrastructure. Furthermore, it has not yet been determined whether there are substantial interracial and ethnic differences in the clinical characteristics, comorbidities, and anatomic features, as well as procedural and long-term outcomes, in patients receiving TAVR. In this review, we provide not only a comprehensive look at the current status and outcomes of TAVR in Asian populations compared with those of Western populations but also a perspective on the future of TAVR in Asia.
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Key Words
- AR, aortic regurgitation
- AS, aortic stenosis
- BAV, bicuspid aortic valve
- BSA, body surface area
- PPI, permanent pacemaker insertion
- PPM, patient-prosthesis mismatch
- PVL, paravalvular leak
- RCT, randomized clinical trial
- SAVR, surgical aortic valve replacement
- STS, Society of Thoracic Surgeons
- TAVR, transcatheter aortic valve replacement
- VHD, valvular heart disease
- aortic stenosis
- outcomes
- race and ethnicity
- valvular disease
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Affiliation(s)
- Cheol Hyun Lee
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Deagu, South Korea
| | - Taku Inohara
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Duk-Woo Park
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Ng ACT, Delgado V, Kong WKF, Bax JJ. Lessons from an International Bicuspid Aortic Valve Disease Registry: the Raphe and Beyond. Heart Lung Circ 2018; 27:782-784. [PMID: 29857976 DOI: 10.1016/s1443-9506(18)30472-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Arnold C T Ng
- Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, Brisbane, Qld, Australia; Translational Research Institute, Brisbane, Qld, Australia; Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - William K F Kong
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands; Department of Cardiology, National University Heart Centre, Singapore
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
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Miśkowiec D, Lipiec P, Szymczyk E, Wejner-Mik P, Michalski B, Kupczyńska K, Wierzbowska-Drabik K, Kasprzak JD. Bicuspid aortic valve morphology and its impact on aortic diameters-A systematic review with meta-analysis and meta-regression. Echocardiography 2018; 35:667-677. [PMID: 29399873 DOI: 10.1111/echo.13818] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
AIM To evaluate the impact of the 2 most common bicuspid aortic valve (BAV) morphology patterns [right-left (RL) vs right-noncoronary (RN) cusp fusion] on the aortic diameters and the impact of gender, aortic stenosis (AS), aortic regurgitation (AR), and age on the observed effects. METHODS The PubMed databases was searched up to December 31, 2016 to identify studies investigating the morphology of BAV and aortic diameters. Inclusion criteria were as follows: the data on diameter of sinuses of Valsalva (SVD) and/or ascending aorta (AAD) and BAV morphology. The additional characteristics [gender, AS and AR (% of patients with moderate or severe AS/AR) and mean age] were collected to perform a meta-regression analysis. RESULTS A total of 12 studies with 2192 patients with indexed AAD, 15 studies with 3104 patients with nonindexed AAD and 8 studies with 1271 patients with indexed SVD, and 16 studies with 3454 patients with nonindexed SVD were included. There was no difference between RL and RN group in indexed/nonindexed AAD-mean difference (MD): 0.06 mm/m2 (95% CI: -0.65 to 0.77 mm/m2 , P = .87) and -0.06 mm (95% CI: 1.10-0.97 mm, P = .91). Differently, the RL BAV was associated with larger indexed/nonindexed SVD than RN phenotype-MD: 1.66 mm/m2 (95% CI: 0.83-2.49 mm/m2 , P < .001) and 2.03 mm (95% CI: 0.97-3.09 mm, P < .001). Age, gender, AS, and AR had no influence on observed differences. CONCLUSIONS RL BAV phenotype is associated with larger SVD than RN BAV, and the observed differences are independent from aortic valve dysfunction degree, age, and gender.
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Affiliation(s)
- Dawid Miśkowiec
- Department of Cardiology, Medical University of Lodz, Lodz, Poland
| | - Piotr Lipiec
- Department of Cardiology, Medical University of Lodz, Lodz, Poland
| | - Ewa Szymczyk
- Department of Cardiology, Medical University of Lodz, Lodz, Poland
| | | | - Błażej Michalski
- Department of Cardiology, Medical University of Lodz, Lodz, Poland
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Kong WKF, Regeer MV, Poh KK, Yip JW, van Rosendael PJ, Yeo TC, Tay E, Kamperidis V, van der Velde ET, Mertens B, Ajmone Marsan N, Delgado V, Bax JJ. Inter-ethnic differences in valve morphology, valvular dysfunction, and aortopathy between Asian and European patients with bicuspid aortic valve. Eur Heart J 2017; 39:1308-1313. [DOI: 10.1093/eurheartj/ehx562] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 09/17/2017] [Indexed: 12/22/2022] Open
Affiliation(s)
- William K F Kong
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
- Department of Cardiology, National University Heart Centre, National University Health System, 5 Lower Kent Ridge Rd, 119074 Singapore
| | - Madelien V Regeer
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Kian K Poh
- Department of Cardiology, National University Heart Centre, National University Health System, 5 Lower Kent Ridge Rd, 119074 Singapore
| | - James W Yip
- Department of Cardiology, National University Heart Centre, National University Health System, 5 Lower Kent Ridge Rd, 119074 Singapore
| | - Philippe J van Rosendael
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Tiong C Yeo
- Department of Cardiology, National University Heart Centre, National University Health System, 5 Lower Kent Ridge Rd, 119074 Singapore
| | - Edgar Tay
- Department of Cardiology, National University Heart Centre, National University Health System, 5 Lower Kent Ridge Rd, 119074 Singapore
| | - Vasileios Kamperidis
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
- Department of Cardiology, AHEPA University Hospital, St.Kiriakidis 1, PO Box 54636 Thessaloniki, Greece
| | - Enno T van der Velde
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Bart Mertens
- Medical Statistics Department, Leiden University Medical Center, Albinusdreef 2, 2300RC Leiden, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
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Hillebrand M, Koschyk D, Ter Hark P, Schüler H, Rybczynski M, Berger J, Gulati A, Bernhardt AM, Detter C, Girdauskas E, Blankenberg S, von Kodolitsch Y. Diagnostic accuracy study of routine echocardiography for bicuspid aortic valve: a retrospective study and meta-analysis. Cardiovasc Diagn Ther 2017; 7:367-379. [PMID: 28890873 DOI: 10.21037/cdt.2017.05.03] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Transthoracic echocardiography (TTE) is the standard procedure to distinguish tricuspid aortic valve (TAV) from bicuspid aortic valve (BAV). Published studies assessed the accuracy of TTE for BAV under ideal conditions. Conversely, we aimed at assessing accuracy of TTE for BAV under routine conditions. METHODS This retrospective, cross-sectional study of 216 adults included 132 men aged 62±14 years. Of these, 108 had BAV and 108 were age-matched individuals with TAV. All diagnoses were confirmed at surgery. We assessed TTE in two patient groups. First, in the (I) group of all 216 individuals, where we assessed accuracy for BAV according to the original diagnoses as documented by the primary investigators during original TTE examination. Second, we assessed accuracy for BAV according to expert re-evaluation in (II) all 158 TTE with availability of original recordings. Third, we performed a meta-analysis of published results on the accuracy of TTE for BAV according to PRISMA standards. RESULTS Sensitivity, specificity and accuracy of (I) primary investigators was 46.3%, 97.2, and 71.8% as compared to (II) expert re-evaluation with 59.7%, 93%, and 77.8%, respectively. Sensitivity was significantly higher at re-evaluation (P<0.001). TTE at a non-tertiary care center (P=0.012), presence of aortic aneurysm (P=0.001) and presence of severe aortic valve calcification (P=0.003) predicted an inaccurate diagnosis of BAV. Conversely, meta-analysis of published TTE studies identified a pooled sensitivity of 87.7% and a pooled specificity of 88.3% for BAV. CONCLUSIONS 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.
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Affiliation(s)
- Mathias Hillebrand
- Centre of Cardiology and Cardiovascular Surgery, University Hospital Eppendorf, Hamburg, Germany
| | - Dietmar Koschyk
- Centre of Cardiology and Cardiovascular Surgery, University Hospital Eppendorf, Hamburg, Germany
| | - Pia Ter Hark
- Centre of Cardiology and Cardiovascular Surgery, University Hospital Eppendorf, Hamburg, Germany
| | - Helke Schüler
- Centre of Cardiology and Cardiovascular Surgery, University Hospital Eppendorf, Hamburg, Germany
| | - Meike Rybczynski
- Centre of Cardiology and Cardiovascular Surgery, University Hospital Eppendorf, Hamburg, Germany
| | - Jürgen Berger
- Department of Medical Biometry and Epidemiology, University Hospital Eppendorf, Hamburg, Germany
| | - Amit Gulati
- Department of Medical Biometry and Epidemiology, University Hospital Eppendorf, Hamburg, Germany
| | - Alexander M Bernhardt
- Centre of Cardiology and Cardiovascular Surgery, University Hospital Eppendorf, Hamburg, Germany
| | - Christian Detter
- Centre of Cardiology and Cardiovascular Surgery, University Hospital Eppendorf, Hamburg, Germany
| | - Evaldas Girdauskas
- Centre of Cardiology and Cardiovascular Surgery, University Hospital Eppendorf, Hamburg, Germany
| | - Stefan Blankenberg
- Centre of Cardiology and Cardiovascular Surgery, University Hospital Eppendorf, Hamburg, Germany
| | - Yskert von Kodolitsch
- Centre of Cardiology and Cardiovascular Surgery, University Hospital Eppendorf, Hamburg, Germany
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Cantinotti M, Giordano R, Clemente A, Assanta N, Murzi M, Murzi B, Crocetti M, Marotta M, Scalese M, Kutty S, Iervasi G. Strengths and Limitations of Current Adult Nomograms for the Aorta Obtained by Noninvasive Cardiovascular Imaging. Echocardiography 2016; 33:1046-68. [PMID: 27060285 DOI: 10.1111/echo.13232] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Normalized measurements for the evaluation of aortic disease severity are preferred to the adoption of generic cutoff values. The purpose of this review is to evaluate the strengths and limitations of currently available aortic nomograms by echocardiography, computed tomography (CT), and magnetic resonance imaging (MRI). A literature search was conducted accessing the National Library of Medicine using the keywords normal values, aorta, echocardiography, CT, and MRI. Addition of these keywords further refined the results: reference values, nomograms, aortic arch, and adults. Thirty studies were included in the final analysis. Despite the strengths noted in the recent investigations, multiple methodological and numerical limitations emerged. The numerical limitations included sample size limitation in most of the studies (only few investigations consisted of >800 subjects and many had 70-300), lack of aortic arch measurements, and paucity of data for non-Caucasian subjects. Methodological limitations consisted of lack of standardization in measurements (systole vs. diastole, internal vs. external border, axial vs. orthogonal planes), heterogeneity and data normalization issues (various age intervals used, body size often not evaluated, data expressed as observed values rather than estimated values by z-score), and study design issues. The designs were mostly retrospective with poorly defined inclusion and exclusion criteria. The nomograms presented range of normality with significant differences, but also with some reproducible pattern. Despite recent advances, multiple methodological or numerical limitations exist in adult nomograms for the aorta. Comprehensive nomograms of aortic dimensions at multiple levels including the aortic arch for different imaging techniques, involving a wide sample size, and using standardized methodology for measurements and data normalization are warranted. The availability of robust nomograms may encourage the use of personalized rather than generic cutoff values.
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Affiliation(s)
| | | | - Alberto Clemente
- G. Monasterio Foundation CNR-Region Toscana, Massa and Pisa, Italy
| | - Nadia Assanta
- G. Monasterio Foundation CNR-Region Toscana, Massa and Pisa, Italy
| | - Michele Murzi
- G. Monasterio Foundation CNR-Region Toscana, Massa and Pisa, Italy
| | - Bruno Murzi
- G. Monasterio Foundation CNR-Region Toscana, Massa and Pisa, Italy
| | - Maura Crocetti
- G. Monasterio Foundation CNR-Region Toscana, Massa and Pisa, Italy
| | - Marco Marotta
- G. Monasterio Foundation CNR-Region Toscana, Massa and Pisa, Italy
| | | | - Shelby Kutty
- University of Nebraska Medical Center and Children's Hospital, Omaha, Nebraska
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Shenoy C, Maron MS, Pandian NG. Cardiovascular magnetic resonance imaging for bicuspid aortic valve syndrome: the time is now. Eur Heart J Cardiovasc Imaging 2014; 15:612-4. [PMID: 24723671 DOI: 10.1093/ehjci/jeu055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Chetan Shenoy
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Martin S Maron
- Hypertrophic Cardiomyopathy Center, Division of Cardiology, Department of Medicine, Tufts Medical Center, Boston, MA, USA Cardiovascular Imaging and Hemodynamic Laboratory, Division of Cardiology, Department of Medicine, Tufts Medical Center, 800 Washington Street, #32, Boston, MA 02111, USA
| | - Natesa G Pandian
- Cardiovascular Imaging and Hemodynamic Laboratory, Division of Cardiology, Department of Medicine, Tufts Medical Center, 800 Washington Street, #32, Boston, MA 02111, USA
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