1
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Pang L, Colantonio MA, Arvon J, Raybuck B, Balla S. Case report: unravelling the puzzle of unicuspid aortic valve with multimodality imaging. Eur Heart J Case Rep 2024; 8:ytae269. [PMID: 38895171 PMCID: PMC11184979 DOI: 10.1093/ehjcr/ytae269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 05/15/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024]
Abstract
Background Unicuspid aortic valve (UAV) represents a rare congenital anomaly characterized by two subtypes: acommissural unicuspid aortic valve and unicommissural unicuspid aortic valve. Acommissural UAV is often diagnosed and corrected during the neonatal period due to haemodynamic instability. Unicommissural UAV leads to aortic stenosis (AS) in early adulthood. The diagnostic challenge associated with UAV primarily stems from its eccentric orifice opening and valvular calcification, resulting in difficult visualization of the commissures and localization of the orifice plane. This case report aims to demonstrate the unique morphological features of UAV through a comprehensive analysis using multimodality imaging. Case summary A 61-year-old woman presented to the emergency department for recurrent episodes of dyspnoea. Severe AS was diagnosed on transthoracic echocardiography (TTE) by Doppler haemodynamic measurement. However, follow-up transesophageal echocardiography (TEE) and CT transcatheter aortic valve replacement showed moderate AS by planimetry. Following this, patient was monitored closely, but her dyspnoea kept worsening. Cardiovascular magnetic resonance (CMR) was performed due to persistent dyspnoea, identifying UAV with eccentric loophole orifice with unicommissural attachment and opposite free leaflet edge. The patient was managed medically. Discussion TTE is the test of choice for AS that defines valvular morphology by direct visualization and grades the severity by haemodynamic measurement. However, the accuracy of TTE can be limited by poor acoustic windows and heavy valvular calcification. TEE measures aortic valve area (AVA) by planimetry that requires accurate localization of the AV orifice plane. Similarly, it applies to multi-detector computed tomography (MDCT). While CMR is expensive and mainly available in tertiary centres, it can provide additional information when there is discordance.
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Affiliation(s)
- Li Pang
- Heart and Vascular Institute, West Virginia University, 1 Medical Center Drive, Morgantown, WV 26505, USA
| | - Mark A Colantonio
- Department of Medicine, West Virginia University, 1 Medical Center Drive, Morgantown, WV 26505, USA
| | - Jessica Arvon
- Department of Medicine, West Virginia University, 1 Medical Center Drive, Morgantown, WV 26505, USA
| | - Bryan Raybuck
- Heart and Vascular Institute, West Virginia University, 1 Medical Center Drive, Morgantown, WV 26505, USA
| | - Sudarshan Balla
- Heart and Vascular Institute, West Virginia University, 1 Medical Center Drive, Morgantown, WV 26505, USA
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2
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Hassanabad AF, Kim T, Adams C. A rare and unique case: aortic valve replacement in a young adult with a stenotic unicommissural unicuspid aortic valve. Future Cardiol 2024; 20:5-10. [PMID: 38189260 DOI: 10.2217/fca-2022-0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 10/12/2023] [Indexed: 01/09/2024] Open
Abstract
Unicuspid aortic valve (UAV) is a rare congenital cardiac anomaly. There are two forms of UAV, including unicuspid acommissural and unicuspid unicommissural. Definitive management for UAV is surgical intervention, but due to the rarity of UAV, the long-term surgical outcomes as well as overall prognosis are not known. Here, we present the case of a 19-year-old patient who was found to have a UAV prenatally and underwent a mechanical aortic valve replacement through an upper hemi-sternotomy due to elevated aortic stenosis gradients and presence of symptoms.
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Affiliation(s)
| | - Tiffany Kim
- Section of Cardiac Surgery, Libin Cardiovascular Institute, Calgary, Canada
| | - Corey Adams
- Section of Cardiac Surgery, Libin Cardiovascular Institute, Calgary, Canada
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3
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Sabbah BN, Arabi TZ, Shafqat A, Abdulkader HS, Alamri F, Kholaif N. The hidden unicuspid: Recurring aortic stenosis post-valvuloplasty from a unicuspid aortic valve masquerading as bicuspid. J Cardiol Cases 2023; 28:213-215. [PMID: 38024116 PMCID: PMC10658333 DOI: 10.1016/j.jccase.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/03/2023] [Accepted: 07/18/2023] [Indexed: 12/01/2023] Open
Abstract
Unicuspid aortic valves (UAV) account for 0.2 % of cardiac valvular disorders and present with early-onset aortic stenosis (AS) during adolescence or early adulthood. We present a case of a 17-year-old male with recurring AS. He was diagnosed with bicuspid aortic valve (BAV) two years previously and treated with balloon valvuloplasty, which relieved symptoms before that. Multimodality imaging work-up revealed the precise morphology of UAV, consistent with the surgical findings. The patient received a St. Jude mechanical valve (St Paul; MN, USA) which resolved his symptoms. A thorough radiologic evaluation is therefore required for the accurate diagnosis of UAVs. While 2-dimensional (2D) transthoracic echocardiography (TTE) often constitutes the initial modality for evaluating UAVs, 3D-TTE, transesophageal echocardiography, and cardiac computed tomography are used as confirmatory diagnostic tools. Balloon valvuloplasty reports good outcomes in BAV but is associated with an increased rate of symptom recurrence, repeated surgical procedures, and higher mortality in UAVs, underscoring the importance of an accurate pre-operative diagnosis. Learning objectives 1.Unicuspid aortic valve (UAV) should be considered in the differential diagnosis of severe aortic stenosis during childhood.2.3D-transthoracic echocardiogram, transesophageal echocardiogram, and cardiac computed tomography (CT) can confirm the diagnosis of a UAV.3.Cardiac CT can additionally assess for accompanying abnormalities of the great vessels in UAV patients.4.Balloon valvuloplasty reports good outcomes in bicuspid aortic valve but is associated with an increased rate of symptom recurrence in UAV patients.
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Affiliation(s)
- Belal N. Sabbah
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Tarek Z. Arabi
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Areez Shafqat
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Faisal Alamri
- Heart Center, King Faisal Specialist Hospital, Riyadh, Saudi Arabia
| | - Naji Kholaif
- Heart Center, King Faisal Specialist Hospital, Riyadh, Saudi Arabia
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4
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The study of the relationship between unicuspid aortic valve insufficiency and heart disease by fluid-structure interaction modeling. BIOMEDICAL ENGINEERING ADVANCES 2023. [DOI: 10.1016/j.bea.2023.100079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
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5
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Rosalia L, Ozturk C, Coll-Font J, Fan Y, Nagata Y, Singh M, Goswami D, Mauskapf A, Chen S, Eder RA, Goffer EM, Kim JH, Yurista S, Bonner BP, Foster AN, Levine RA, Edelman ER, Panagia M, Guerrero JL, Roche ET, Nguyen CT. A soft robotic sleeve mimicking the haemodynamics and biomechanics of left ventricular pressure overload and aortic stenosis. Nat Biomed Eng 2022; 6:1134-1147. [PMID: 36163494 PMCID: PMC9588718 DOI: 10.1038/s41551-022-00937-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/12/2022] [Indexed: 12/14/2022]
Abstract
Preclinical models of aortic stenosis can induce left ventricular pressure overload and coarsely control the severity of aortic constriction. However, they do not recapitulate the haemodynamics and flow patterns associated with the disease. Here we report the development of a customizable soft robotic aortic sleeve that can mimic the haemodynamics and biomechanics of aortic stenosis. By allowing for the adjustment of actuation patterns and blood-flow dynamics, the robotic sleeve recapitulates clinically relevant haemodynamics in a porcine model of aortic stenosis, as we show via in vivo echocardiography and catheterization studies, and a combination of in vitro and computational analyses. Using in vivo and in vitro magnetic resonance imaging, we also quantified the four-dimensional blood-flow velocity profiles associated with the disease and with bicommissural and unicommissural defects re-created by the robotic sleeve. The design of the sleeve, which can be adjusted on the basis of computed tomography data, allows for the design of patient-specific devices that may guide clinical decisions and improve the management and treatment of patients with aortic stenosis.
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Affiliation(s)
- Luca Rosalia
- Health Sciences and Technology Program, Harvard - Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, USA,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, 45 Carleton Street, Cambridge, MA 02139, USA,Cardiovascular Research Center, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129, USA,A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 149 13th Street Charlestown, MA 02129, USA
| | - Caglar Ozturk
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, 45 Carleton Street, Cambridge, MA 02139, USA
| | - Jaume Coll-Font
- Cardiovascular Research Center, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129, USA,A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 149 13th Street Charlestown, MA 02129, USA
| | - Yiling Fan
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, 45 Carleton Street, Cambridge, MA 02139, USA,Cardiovascular Research Center, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129, USA,A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 149 13th Street Charlestown, MA 02129, USA,Department of Mechanical Engineering, Massachusetts Institute of Technology, 33 Massachusetts Avenue, Cambridge, MA 02139, USA
| | - Yasufumi Nagata
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, 55 Fruit Boston, MA 02114, USA,Department of Medicine, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Manisha Singh
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, 45 Carleton Street, Cambridge, MA 02139, USA
| | - Debkalpa Goswami
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, 45 Carleton Street, Cambridge, MA 02139, USA
| | - Adam Mauskapf
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, 55 Fruit Boston, MA 02114, USA
| | - Shi Chen
- Cardiovascular Research Center, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129, USA,A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 149 13th Street Charlestown, MA 02129, USA
| | - Robert A. Eder
- Cardiovascular Research Center, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129, USA,A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 149 13th Street Charlestown, MA 02129, USA
| | - Efrat M. Goffer
- Health Sciences and Technology Program, Harvard - Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, USA,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, 45 Carleton Street, Cambridge, MA 02139, USA
| | - Jo H. Kim
- Cardiovascular Research Center, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129, USA,A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 149 13th Street Charlestown, MA 02129, USA
| | - Salva Yurista
- Cardiovascular Research Center, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129, USA,A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 149 13th Street Charlestown, MA 02129, USA
| | - Benjamin P. Bonner
- Cardiovascular Research Center, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129, USA,A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 149 13th Street Charlestown, MA 02129, USA
| | - Anna N. Foster
- Cardiovascular Research Center, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129, USA,A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 149 13th Street Charlestown, MA 02129, USA
| | - Robert A. Levine
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, 55 Fruit Boston, MA 02114, USA,Department of Medicine, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Elazer R. Edelman
- Health Sciences and Technology Program, Harvard - Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, USA,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, 45 Carleton Street, Cambridge, MA 02139, USA,Brigham and Women’s Hospital, Cardiovascular Division, 75 Francis Street, Boston, MA 02115, USA
| | - Marcello Panagia
- Cardiovascular Research Center, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129, USA,Cardiovascular Medicine Section, Department of Medicine, Boston University Medical Center, 715 Albany Street, Boston, MA 02118, USA
| | - Jose L. Guerrero
- Cardiovascular Research Center, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129, USA
| | - Ellen T. Roche
- Health Sciences and Technology Program, Harvard - Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, USA,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, 45 Carleton Street, Cambridge, MA 02139, USA,Department of Mechanical Engineering, Massachusetts Institute of Technology, 33 Massachusetts Avenue, Cambridge, MA 02139, USA,Correspondence and requests for materials should be addressed to ;
| | - Christopher T. Nguyen
- Health Sciences and Technology Program, Harvard - Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, USA,Cardiovascular Research Center, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129, USA,A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 149 13th Street Charlestown, MA 02129, USA,Department of Medicine, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA,Cardiovascular Innovation Research Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA,Correspondence and requests for materials should be addressed to ;
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6
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Sharma R, Patel P, Sattiraju S, Catanzaro JN. One-leaf clover: a rare case of a unicuspid unicommissural aortic valve. Eur Heart J Case Rep 2021; 5:ytab424. [PMID: 34993397 PMCID: PMC8728723 DOI: 10.1093/ehjcr/ytab424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/13/2021] [Accepted: 10/14/2021] [Indexed: 12/03/2022]
Affiliation(s)
- Radhika Sharma
- Division of Cardiology, Department of Internal Medicine, University of Florida, 655 W 8th St, 5th Floor, Ambulatory Care Center, Jacksonville, FL 32209, USA
| | - Pujan Patel
- Division of Cardiology, Department of Internal Medicine, University of Florida, 655 W 8th St, 5th Floor, Ambulatory Care Center, Jacksonville, FL 32209, USA
| | - Srinivasan Sattiraju
- Division of Cardiology, Department of Internal Medicine, University of Florida, 655 W 8th St, 5th Floor, Ambulatory Care Center, Jacksonville, FL 32209, USA
| | - John N Catanzaro
- Division of Cardiology, Department of Internal Medicine, University of Florida, 655 W 8th St, 5th Floor, Ambulatory Care Center, Jacksonville, FL 32209, USA
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7
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Kubota S, Hara H, Hiroi Y. Current status and future perspectives of onco-cardiology: Importance of early detection and intervention for cardiotoxicity, and cardiovascular complication of novel cancer treatment. Glob Health Med 2021; 3:214-225. [PMID: 34532602 DOI: 10.35772/ghm.2021.01024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/07/2021] [Accepted: 06/18/2021] [Indexed: 12/20/2022]
Abstract
The prognosis has improved remarkably in recent years with the development of cancer treatment. With the increase in the number of cancer survivors, complications of cardiovascular disease have become a problem. Therefore, the field of onco-cardiology has been attracting attention. The field of onco-cardiology covers a wide range of areas. In the past, cardiac dysfunction caused by cardiotoxic drug therapies such as doxorubicin (Adriamycin) was the most common cause of cardiac dysfunction, but nowadays, cardiovascular complications caused by aging cancer survivors, atherosclerotic disease in cardiovascular risk carriers, thromboembolism, and new drugs (e.g., myocarditis caused by immune checkpoint inhibitors and hypertension caused by angiogenesis) are becoming more common. In this review, we summarize the latest findings of cardiotoxicity of cancer therapy, appropriate treatment and prevention, and cardiovascular complications of novel chemotherapy, which will increase in demand in the near future.
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Affiliation(s)
- Shuji Kubota
- Department of Cardiology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hisao Hara
- Department of Cardiology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yukio Hiroi
- Department of Cardiology, National Center for Global Health and Medicine, Tokyo, Japan
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8
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Suraci N, Lo Presti S, D'Mello J, Xydas S, Mihos CG. Unicuspid aortic valve: Case series and review. Echocardiography 2020; 37:2155-2159. [PMID: 33040421 DOI: 10.1111/echo.14885] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/10/2020] [Accepted: 09/20/2020] [Indexed: 11/29/2022] Open
Abstract
A unicuspid aortic valve is a very rare valvular lesion. Its physical manifestations vary and are associated with other cardiovascular abnormalities such as aortic stenosis/insufficiency and aortopathy. Echocardiography remains the modality of choice, with computerized tomography or cardiac magnetic resonance used as adjunctive imaging. Herein, we present a case series of three patients with unicuspid aortic valves treated at our institution, with a focus on 2D and 3D echocardiographic imaging.
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Affiliation(s)
- Nicholas Suraci
- Department of Anesthesiology, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Saberio Lo Presti
- Echocardiography Laboratory, Division of Cardiology, Mount Sinai Heart Institute, Columbia University, Miami Beach, FL, USA
| | - Jayanand D'Mello
- Department of Anesthesiology, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Steve Xydas
- Department of Cardiothoracic Surgery, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Christos G Mihos
- Echocardiography Laboratory, Division of Cardiology, Mount Sinai Heart Institute, Columbia University, Miami Beach, FL, USA
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9
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Naito S, Sequeira-Gross T, Petersen J, Holst T, Reichenspurner H, Girdauskas E. Focus on a rare clinical entity: unicuspid aortic valve disease. Expert Rev Cardiovasc Ther 2020; 18:625-633. [DOI: 10.1080/14779072.2020.1811685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Shiho Naito
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Tatiana Sequeira-Gross
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Johannes Petersen
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Theresa Holst
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Evaldas Girdauskas
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
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10
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Kowalczys A, Bohdan M, Fijałkowska J, Duda M, Gruchała M, Fijałkowski M. Rare Case of an Adult With a Stenotic Acommissural Unicuspid Aortic Valve. Can J Cardiol 2020; 36:1832.e7-1832.e8. [PMID: 32442475 DOI: 10.1016/j.cjca.2020.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/24/2020] [Accepted: 05/10/2020] [Indexed: 10/24/2022] Open
Affiliation(s)
- Anna Kowalczys
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland.
| | - Michał Bohdan
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | | | - Maciej Duda
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Gdansk, Poland
| | - Marcin Gruchała
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Marcin Fijałkowski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
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11
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Persistent left superior vena cava and double-lumen aortic arch in a patient with a stenotic unicuspid aortic valve. Rev Port Cardiol 2020; 39:49-51. [PMID: 32156448 DOI: 10.1016/j.repc.2019.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 07/03/2019] [Accepted: 09/08/2019] [Indexed: 11/21/2022] Open
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12
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Persistent left superior vena cava and double-lumen aortic arch in a patient with a stenotic unicuspid aortic valve. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.repce.2019.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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13
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Park SJ, Lee JH, Chung ES. Bentall Operation in a Patient with a Unicommissural Unicuspid Aortic Valve. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 52:368-371. [PMID: 31624715 PMCID: PMC6785160 DOI: 10.5090/kjtcs.2019.52.5.368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/26/2019] [Accepted: 07/29/2019] [Indexed: 11/23/2022]
Abstract
A unicuspid aortic valve is a rare congenital malformation that frequently presents with valvular dysfunction and dilatation or aortic aneurysm, requiring combined aortic valve surgery and aortic repair. Some patients show severe valve calcification extending into the interventricular septum, possibly resulting in damage to the conduction system during debridement for valve replacement. We present a rare case of severe aortic stenosis with a unicommissural unicuspid aortic valve diagnosed by preoperative transesophageal echocardiography in a 36-year-old man. After composite graft replacement of the aortic valve, aortic root, and ascending aorta, a permanent pacemaker was placed because of postoperative complete heart block.
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Affiliation(s)
- Sung Joon Park
- Department of Thoracic and Cardiovascular Surgery, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jae Hoon Lee
- Department of Thoracic and Cardiovascular Surgery, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Eui Suk Chung
- Department of Thoracic and Cardiovascular Surgery, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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14
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De Rubeis G, Galea N, Ceravolo I, Dacquino GM, Carbone I, Catalano C, Francone M. Aortic valvular imaging with cardiovascular magnetic resonance: seeking for comprehensiveness. Br J Radiol 2019; 92:20170868. [PMID: 30277407 PMCID: PMC6732913 DOI: 10.1259/bjr.20170868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 09/05/2018] [Accepted: 09/23/2018] [Indexed: 12/18/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) has an emerging role in aortic valve disease evaluation, becoming an all-in-one technique. CMR evaluation of the anatomy and flow through the aortic valve has a higher reproducibility than echocardiography. Its unique ability of in vivo myocardial tissue characterization, significantly improves the risk stratification and management of patients. In addition, CMR is equivalent to cardiac CT angiography for trans-aortic valvular implantation and surgical aortic valve replacement planning; on the other hand, its role in the evaluation of ventricular function improving and post-treatment complications is undisputed. This review encompasses the existing literature regarding the role of CMR in aortic valve disease, exploring all the aspects of the disease, from diagnosis to prognosis.
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Affiliation(s)
- Gianluca De Rubeis
- Department of Radiological, Oncological and Pathological Sciences,"Sapienza” University of Rome, Rome, Italy
| | | | - Isabella Ceravolo
- Department of Radiological, Oncological and Pathological Sciences,"Sapienza” University of Rome, Rome, Italy
| | - Gian Marco Dacquino
- Department of Radiological, Oncological and Pathological Sciences,"Sapienza” University of Rome, Rome, Italy
| | - Iacopo Carbone
- Department of Radiological, Oncological and Pathological Sciences,"Sapienza” University of Rome, Rome, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences,"Sapienza” University of Rome, Rome, Italy
| | - Marco Francone
- Department of Radiological, Oncological and Pathological Sciences,"Sapienza” University of Rome, Rome, Italy
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15
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Chang HH, Cheng CL, Wang WC, Huang PJ, Lin SY. Assessment of Unicuspid Aortic Valve Stenosis Using Multimodality Imaging, X-ray Radiography and Raman Analysis. Int Heart J 2019; 60:482-488. [DOI: 10.1536/ihj.18-338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Hsiao-Huang Chang
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital
| | - Ching-Li Cheng
- Department of Nursing, National Tainan Institute of Nursing
| | - Wei-Chen Wang
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital
| | - Pei-Jung Huang
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital
| | - Shan-Yang Lin
- Department of Biotechnology and Pharmaceutical Technology, Yuanpei University of Medical Technology
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16
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Armstrong J, Crawford J, Arnautovic J. Unicuspid aortic valve replacement with development of complete heart block: a case report. Eur Heart J Case Rep 2019; 3:ytz026. [PMID: 31020268 PMCID: PMC6458860 DOI: 10.1093/ehjcr/ytz026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 02/20/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Aortic stenosis is a progressive disease that frequently remains undiagnosed until late in the disease course. In patients that present with symptoms of heart failure and a systolic murmur at a young age, a congenital valvular abnormality must be on the differential. With patients that have accelerated symptoms of aortic stenosis and valvular dysfunction, a unicuspid aortic valve (UAV) could be present. A UAV is often difficult to distinguish from a bicuspid aortic valve (BAV) on transthoracic echocardiography. In patients with congenital valvular abnormalities an ascending aortic aneurysm can also be present. Aortic stenosis changes the jet of fluid emerging from the aortic valve leading to an increased risk for aortic aneurysm dissection and rupture. The gold standard treatment for aortic stenosis secondary to a congenital valvular abnormality is valve replacement. A known risk of aortic valve replacement is conduction abnormalities. In this case, we present a patient with a unicuspid valve who postoperatively develops complete heart block leading to pacemaker implantation. CASE SUMMARY We present a case of a 46-year-old Caucasian male with no prior medical history who presented with progressively worsening exertional dyspnoea and palpitations for 7 months. Transthoracic echocardiogram showed a BAV, however, further work up confirmed a unicommissural aortic valve with severe aortic stenosis and moderate regurgitation along with an ascending aortic aneurysm. Aortic valve replacement and aortic aneurysm repair via the Bentall procedure was successfully completed with postoperative course being complicated by a complete heart block and subsequent permanent pacemaker placement. DISCUSSION When assessing patients with symptoms of heart failure with a systolic murmur that suggests aortic stenosis at a young age, a UAV must be kept on the differential. The symptoms of aortic stenosis and valvular dysfunction are accelerated in UAVs when compared with BAVs. Currently, the treatment for patients with congenital valvular abnormalities presenting with aortic stenosis is aortic valve replacement using traditional open surgery. A known sequelae of isolated aortic valve replacement is conduction abnormalities that can sometimes lead to permanent pacemaker placement. After the confirmation of unicuspid or bicuspid valve postoperatively, it is important to report any postoperative conduction abnormalities. This is because, currently, there is no literature that compares the incidence of conduction abnormalities after unicuspid replacement to that of other BAV syndromes.
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Affiliation(s)
- Justin Armstrong
- Cardiovascular Department, Ascension Macomb Hospital, Warren, MI, USA
| | - Joan Crawford
- Cardiovascular Department, Ascension Macomb Hospital, Warren, MI, USA
| | - Jelena Arnautovic
- Cardiovascular Department, Ascension Macomb Hospital, Warren, MI, USA
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Miura S, Inoue K, Yamada S, Yamashita T, Ando K. Two rare cases of congenital aortic stenosis showing a discrepancy between preoperative imaging diagnosis, intraoperative findings, and histopathological diagnosis. J Cardiol Cases 2018; 18:13-16. [PMID: 30279901 DOI: 10.1016/j.jccase.2018.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 02/19/2018] [Accepted: 03/07/2018] [Indexed: 11/16/2022] Open
Abstract
Unicuspid aortic valve (UAV) is an extremely rare congenital heart valve abnormality while bicuspid valve (BAV) has been reported as one of the most common cardiac anomalies. With a UAV usually showing similar presentations to a BAV, such as aortic regurgitation or aortic stenosis (AS), it is challenging to differentiate them from each other in clinical settings. Despite some features shared between both valve disorders, there can be a clinical significance in distinguishing UAV from BAV for the management of patients with these heart anomalies. Herein, we describe two cases where patients with hemodynamically severe AS were diagnosed with BAV and UAV, respectively based on preoperative examinations and intraoperative findings, but subsequent pathological examinations confirmed the opposite diagnosis in both cases. <Learning objective: Preoperative diagnosis of congenital aortic valve diseases can often be challenging. There remains a remarkable number of misleading cases. Thus, it is strongly recommended that an accurate diagnosis should be attempted at the earliest stages of congenital aortic valve disease. Additionally, both careful follow-ups using multiple imaging modalities and confirmations via pathological diagnosis for patients undergoing surgery, if they are first found to be at an advanced stage or remain undiagnosed preoperatively are important.>.
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Affiliation(s)
- Shiro Miura
- Department of Cardiology, Hokkaido Ohno Memorial Hospital, Sapporo, Japan
| | - Katsumi Inoue
- Laboratory Medicine, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Satoshi Yamada
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takehiro Yamashita
- Department of Cardiology, Hokkaido Ohno Memorial Hospital, Sapporo, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
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Kolesar A, Toporcer T, Bajmoczi M, Luczy J, Candik P, Sabol F. Aortic Valve Repair of a Stenotic Unicuspid Aortic Valve in Young Patients. Ann Thorac Surg 2018; 105:1351-1356. [PMID: 29391147 DOI: 10.1016/j.athoracsur.2017.12.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 11/02/2017] [Accepted: 12/21/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND The unicuspid aortic valve (UAV) is a well-described pediatric congenital abnormality, with incidence of 0.02% in the general population. Bicuspidization has been described as a potential surgical option to repair this defect. METHODS Seventeen symptomatic young patients with a unicuspid valve combined with either valve insufficiency or valve stenosis underwent aortic valve (AV) bicuspidization procedure by using an equine pericardium. In addition to bicuspidization, 8 patients underwent aortic ring implantation and 5 patients underwent supracoronary replacement of the aorta. RESULTS Our results show safety of the bicuspidization procedure. No deaths occurred during our average follow-up period of 26 months. Freedom from reoperation for any valve-related reason was 100% during this follow-up period. We observed a statistically significant increase in the AV area from 0.8 ± 0.1 cm2 to 2.8 ± 0.7 cm2 (p < 0.01), a statistically significant decrease in the mean systolic pressure gradient from 36 ± 13.3 mm Hg to 9 ± 4 mm Hg (p < 0.001), a statistically significant decrease in aortic insufficiency grade from 2.1 ± 1.0 to 0.6 ± 0.7 (p < 0.01) before and after bicuspidization, respectively, and a statistically significant decrease in the left ventricular end-diastolic diameter from 49.88 ± 5.11 mm to 40.46 ± 7.20 mm (p < 0.0005) and a statistically significant increase of the left ventricular ejection fraction from 56% ± 8.20% to 64% ± 7.83% at the time of follow-up. CONCLUSIONS From our study, bicuspidization is an attractive surgical option to repair UAV, particularly in young patients who do not want to be subjected to long-term anticoagulation therapy or who refuse a more traditional surgical approach, such as Ross procedure, for reasons described previously.
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Affiliation(s)
- Adrian Kolesar
- Clinic of Cardiac Surgery, Eastern Slovak Institute for Cardiovascular Diseases, Ondavska, Slovakia
| | - Tomas Toporcer
- Clinic of Cardiac Surgery, Eastern Slovak Institute for Cardiovascular Diseases, Ondavska, Slovakia.
| | - Milan Bajmoczi
- Harry & Sally Porter Heart & Vascular Center, Fairbanks Memorial Hospital, Fairbanks, Alaska
| | - Jan Luczy
- Clinic of Cardiac Surgery, Eastern Slovak Institute for Cardiovascular Diseases, Ondavska, Slovakia
| | - Peter Candik
- Department of Anesthesiology and Intensive Medicine, Eastern Slovak Institute for Cardiovascular Diseases, Kosice, Slovakia
| | - Frantisek Sabol
- Clinic of Cardiac Surgery, Eastern Slovak Institute for Cardiovascular Diseases, Ondavska, Slovakia
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Reparación de válvula aórtica unicúspide. CIRUGIA CARDIOVASCULAR 2017. [DOI: 10.1016/j.circv.2016.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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A case of very severe aortic stenosis due to unicuspid aortic valve mimicking bicuspid aortic valve with calcification on cardiac computed tomography. Int J Cardiol 2016; 215:516-8. [DOI: 10.1016/j.ijcard.2016.04.142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 04/16/2016] [Indexed: 11/22/2022]
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