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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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Sievers HH. The bicuspid aortic valve complex: still a mystery. Eur J Cardiothorac Surg 2021; 60:479-480. [PMID: 34292340 DOI: 10.1093/ejcts/ezab073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 01/25/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Hans-Hinrich Sievers
- Department of Cardiac and Thoracic Vascular Surgery, University of Luebeck, Luebeck, Germany
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van Wijngaarden AL, Kruithof BPT, Vinella T, Barge-Schaapveld DQCM, Ajmone Marsan N. Characterization of Degenerative Mitral Valve Disease: Differences between Fibroelastic Deficiency and Barlow's Disease. J Cardiovasc Dev Dis 2021; 8:23. [PMID: 33671724 PMCID: PMC7926852 DOI: 10.3390/jcdd8020023] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/17/2021] [Accepted: 02/19/2021] [Indexed: 12/18/2022] Open
Abstract
Degenerative mitral valve disease causing mitral valve prolapse is the most common cause of primary mitral regurgitation, with two distinct phenotypes generally recognized with some major differences, i.e., fibroelastic deficiency (FED) and Barlow's disease. The aim of this review was to describe the main histological, clinical and echocardiographic features of patients with FED and Barlow's disease, highlighting the differences in diagnosis, risk stratification and patient management, but also the still significant gaps in understanding the exact pathophysiology of these two phenotypes.
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Affiliation(s)
- Aniek L. van Wijngaarden
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (A.L.v.W.); (B.P.T.K.)
| | - Boudewijn P. T. Kruithof
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (A.L.v.W.); (B.P.T.K.)
| | - Tommaso Vinella
- Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK;
| | | | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (A.L.v.W.); (B.P.T.K.)
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Borger MA, Fedak PWM, Stephens EH, Gleason TG, Girdauskas E, Ikonomidis JS, Khoynezhad A, Siu SC, Verma S, Hope MD, Cameron DE, Hammer DF, Coselli JS, Moon MR, Sundt TM, Barker AJ, Markl M, Della Corte A, Michelena HI, Elefteriades JA. The American Association for Thoracic Surgery consensus guidelines on bicuspid aortic valve-related aortopathy: Full online-only version. J Thorac Cardiovasc Surg 2019; 156:e41-e74. [PMID: 30011777 DOI: 10.1016/j.jtcvs.2018.02.115] [Citation(s) in RCA: 162] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 01/17/2018] [Accepted: 02/12/2018] [Indexed: 12/11/2022]
Abstract
Bicuspid aortic valve disease is the most common congenital cardiac disorder, being present in 1% to 2% of the general population. Associated aortopathy is a common finding in patients with bicuspid aortic valve disease, with thoracic aortic dilation noted in approximately 40% of patients in referral centers. Several previous consensus statements and guidelines have addressed the management of bicuspid aortic valve-associated aortopathy, but none focused entirely on this disease process. The current guidelines cover all major aspects of bicuspid aortic valve aortopathy, including natural history, phenotypic expression, histology and molecular pathomechanisms, imaging, indications for surgery, surveillance, and follow-up, and recommendations for future research. It is intended to provide clinicians with a current and comprehensive review of bicuspid aortic valve aortopathy and to guide the daily management of these complex patients.
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Affiliation(s)
- Michael A Borger
- Leipzig Heart Center, Cardiac Surgery, University of Leipzig, Leipzig, Germany.
| | - Paul W M Fedak
- Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Thomas G Gleason
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Evaldas Girdauskas
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - John S Ikonomidis
- Division of Cardiothoracic Surgery, University of North Carolina, Chapel Hill, NC
| | - Ali Khoynezhad
- Memorial Care Heart and Vascular Institute, Memorial Care Long Beach Medical Center, Long Beach, Calif
| | - Samuel C Siu
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Subodh Verma
- Department of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Michael D Hope
- San Francisco (UCSF) Department of Radiology & Biomedical Imaging, University of California, San Francisco, Calif
| | - Duke E Cameron
- Department of Cardiac Surgery, Massachusetts General Hospital, Boston, Mass
| | - Donald F Hammer
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Joseph S Coselli
- Division of Cardiothoracic Surgery, Texas Heart Institute, Baylor College of Medicine, Houston, Tex
| | - Marc R Moon
- Section of Cardiac Surgery, Washington University School of Medicine, St Louis, Mo
| | - Thoralf M Sundt
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Mass
| | - Alex J Barker
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Michael Markl
- Departments of Radiology and Biomedical Engineering, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | | | | | - John A Elefteriades
- Department of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, Conn
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Padang R, Enriquez-Sarano M, Pislaru SV, Maalouf JF, Nkomo VT, Mankad SV, Maltais S, Suri RM, Schaff HV, Michelena HI. Coexistent bicuspid aortic valve and mitral valve prolapse: epidemiology, phenotypic spectrum, and clinical implications. Eur Heart J Cardiovasc Imaging 2018; 20:677-686. [DOI: 10.1093/ehjci/jey166] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 08/05/2018] [Accepted: 10/10/2018] [Indexed: 01/03/2023] Open
Affiliation(s)
- Ratnasari Padang
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | | | - Sorin V Pislaru
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Joseph F Maalouf
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Vuyisile T Nkomo
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Sunil V Mankad
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Simon Maltais
- Department of Cardiovascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Rakesh M Suri
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, 9500 Euclid Ave. Cleveland, OH, USA
| | - Hartzell V Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Hector I Michelena
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
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Furukawa H, Tanemoto K. Current topics on bicuspid aortic valve: clinical aspects and surgical management. Ann Thorac Cardiovasc Surg 2015; 21:314-21. [PMID: 26095042 DOI: 10.5761/atcs.ra.15-00130] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Bicuspid aortic valve (BAV) has been identified as the most common heart valve anomaly and is considered to be a heritable disorder that affects various cardiovascular disorders, including aortopathy. Current topics regarding the clinical management of BAV including surgical strategies with or without concomitant aortic repair or replacement are attracting interest, in addition to the pathological and morphological aspects of BAV as well as aortopathy. However, surgical indications are still being debated and are dependent on current clinical guidelines and surgeons' preferences. Although clinical guidelines have already been established for the management of BAV with or without aortopathy, many studies on clinical management and surgical techniques involving various kinds of subjects have previously been published. Although a large number of studies concerning the clinical aspects of BAV have been reviewed in detail, controversy still surrounds the clinical and surgical management of BAV. Therefore, surgeons should carefully consider valve pathology when deciding whether to replace the ascending aorta. In this review, we summarized current topics on BAV and the surgical management of diseased BAV with or without aortopathy based on previous findings, including catheter-based interventional management.
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Affiliation(s)
- Hiroshi Furukawa
- Department of Cardiovascular Surgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
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David TE, Armstrong S, Ivanov J. Chordal replacement with polytetrafluoroethylene sutures for mitral valve repair: A 25-year experience. J Thorac Cardiovasc Surg 2013; 145:1563-9. [DOI: 10.1016/j.jtcvs.2012.05.030] [Citation(s) in RCA: 121] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Revised: 04/15/2012] [Accepted: 05/15/2012] [Indexed: 11/26/2022]
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Charitos EI, Hanke T, Karluss A, Hilker L, Stierle U, Sievers HH. New insights into bicuspid aortic valve disease: the elongated anterior mitral leaflet. Eur J Cardiothorac Surg 2012; 43:367-70. [PMID: 22522978 DOI: 10.1093/ejcts/ezs152] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES The bicuspid aortic valve (BAV) is associated with various cardiovascular malformations, most predominantly with dilatation of the aortic root and ascending aorta. After sporadic observations of various BAV-associated mitral valve pathologies, we sought to systematically examine the mitral valve morphology in patients with a BAV. METHODS Forty-four operated patients with a BAV (type I L/R) and 40 operated patients with a tricuspid aortic valve (TAV) as well as 20 healthy subjects (Normal) were examined by means of transthoracic echocardiography. In all patients, the primary operative indication was aortic valve pathology (stenosis/regurgitation), and no patients with degenerative mitral valve pathology were included. RESULTS In patients with a BAV, the anterior mitral leaflet (AML) was significantly elongated in comparison with patients with a TAV and Normal subjects (33.2 ± 6.6 vs 27.7 ± 3.2 vs 27.0 ± 1.9 mm; P < 0.001). Regression analysis revealed that patients with a BAV had significantly elongated AML (P < 0.001) even after correcting for the mitral annulus (MA) diameter and somatometric characteristics (weight, height, body surface area, age). Furthermore, patients with a BAV and concomitant aortic valve insufficiency had significantly elongated AML in comparison with the other groups (35.2 ± 7.6 vs 28.4 ± 3.7 mm; P < 0.001). This difference persisted even after correcting for MA diameter and somatometric differences (P < 0.001). AML heights >32 mm in patients undergoing aortic root/valve procedures were highly predictive of the presence of a BAV [specificity: 90%, positive predictive value: 82%, area under curve: 0.80 (95% CI: 0.71-0.88)]. CONCLUSIONS We provide evidence that the cardiovascular alterations observed in the BAV are not limited to the aortic valve or ascending aorta but also involve the AML, and seem to be more pronounced in patients with a BAV with concomitant, clinically significant aortic regurgitation.
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Affiliation(s)
- Efstratios I Charitos
- Department of Cardiac and Thoracic Vascular Surgery, University of Luebeck, Luebeck, Germany.
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Roberts WC, Janning KG, Vowels TJ, Ko JM, Hamman BL, Hebeler RF. Presence of a congenitally bicuspid aortic valve among patients having combined mitral and aortic valve replacement. Am J Cardiol 2012; 109:263-71. [PMID: 22019139 DOI: 10.1016/j.amjcard.2011.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 09/02/2011] [Accepted: 09/02/2011] [Indexed: 11/19/2022]
Abstract
Although bicuspid aortic valve occurs in an estimated 1% of adults and mitral valve prolapse in an estimated 5% of adults, occurrence of the 2 in the same patient is infrequent. During examination of operatively excised aortic and mitral valves because of dysfunction (stenosis and/or regurgitation), we encountered 16 patients who had congenitally bicuspid aortic valves associated with various types of dysfunctioning mitral valves. Eleven of the 16 patients had aortic stenosis (AS): 5 of them also had mitral stenosis, of rheumatic origin in 4 and secondary to mitral annular calcium in 1; the other 6 with aortic stenosis had pure mitral regurgitation (MR) secondary to mitral valve prolapse in 3, to ischemia in 2, and to unclear origin in 1. Of the 5 patients with pure aortic regurgitation, each also had pure mitral regurgitation: in 1 secondary to mitral valve prolapse and in 4 secondary to infective endocarditis. In conclusion, various types of mitral dysfunction severe enough to warrant mitral valve replacement occur in patients with bicuspid aortic valves. A proper search for mitral valve dysfunction in patients with bicuspid aortic valves appears warranted.
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Echocardiographic determination of the prevalence of primary myxomatous degeneration of the cardiac valves. J Am Soc Echocardiogr 2011; 24:399-404. [PMID: 21353473 DOI: 10.1016/j.echo.2011.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2009] [Indexed: 11/23/2022]
Abstract
BACKGROUND There is a paucity of data on the prevalence of primary myxomatous degeneration (PMD) of the cardiac valves. Because the gold standard for the diagnosis is pathology, its preoperative detection rate is relatively low. The purposes of this study were to determine the capability of echocardiography to identify PMD compared with surgical pathological findings and to determine the echocardiographic features of PMD. METHODS Echocardiograms were retrospectively compared with pathologic findings in 1,080 patients undergoing surgery for moderate or severe cardiac valve regurgitation. PMD of the mitral, aortic, and tricuspid valves was retrospectively identified, with a comparison of the echocardiographic and pathologic findings, to estimate the prevalence of PMD and to summarize its echocardiographic features. RESULTS Of 1,080 patients, 104 were diagnosed with PMD (prevalence, 9.62%). Echocardiography identified valvular prolapse and thickening in 85% of patients. The echocardiographic characteristics of PMD included valvular regurgitation, valvular thickening, valvular prolapse, and rupture of chordae tendineae. Combinations of these characteristics were seen on multiple valves. Among patients with PMD, 59 had only mitral valve involvement, 25 had only aortic valve involvement, two had only tricuspid valve involvement, 10 had both mitral and aortic valve involvement, and three had both mitral and tricuspid valve involvement. CONCLUSIONS In patients undergoing surgery for valvular regurgitation, a high prevalence of PMD was found. PMD has distinctive echocardiographic features, suggesting its preoperative diagnosis.
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