Bicuspid Aortic Valves

Bicuspid Aortic Valve

Occurs in 1-2% of population Associated with :

aortic coarctation

patent ductus arteriosis

abnormal proximal coronary vasculature

Bicuspid Aortic Valve

Associated with connective tissue problems of aortic root and aorta

Associated with aortic dilation, aneurysm, and dissection

Associated with aortic root dilation

Bicuspid Aortic Valve

Prone to developing aortic stenosis

Aortic root dilation can cause aortic insufficiency

Schematic presentation (as viewed from the surgeon’s position with the left coronary sinus on the left side) of the classification system of BAVs with one main and two subcategories, including the number of specimens (percent in parenthesis)

Bicuspid Aortic Valve

Hans-H. Sievers, MD, and Claudia Schmidtke, MD, MBA. A classification system for the bicuspid aortic valve from 304 surgical specimens. J Thoracic Cardiovasc Surg 2007 133:1226-33.

Bicuspid Aortic Valve

JK 01

Bicuspid Aortic Valve

RN 01

Bicuspid Aortic Valve

Age distribution of bicuspid and tricuspid aortic valve stenosis.

Age (by decades) versus functional state of 535 congenitally bicuspid aortic valves (data for the 7 normally functioning valves are not shown.) Al=aortic insufficiency (regurgitation); AS=aortic stenosis. (Sabet et al)

Bicuspid Aortic Valve with Dilated Ascending AortaClass I Recommendations

4. Surgery to repair the aortic root or replace the ascending aorta is indicated in patients with bicuspid aortic valves if the diameter of the aortic root or ascending aorta is greater than 5.0 cm* or if the rate of increase in diameter is 0.5 cm

per year or more. (Level of Evidence: C)

5. In patients with bicuspid valves undergoing AVR because of severe AS or AR (see Sections 3.1.7 and 3.2.3.8), repair of the aortic root or replacement of the ascending aorta is indicated if the diameter of the aortic root or ascending aorta is greater than 4.5 cm.* (Level of Evidence: C)

2006 Guidelines for the Management of Patients with Valvular Heart Disease

Bicuspid Aortic ValveDilated Root

Comparison of Aortic Root Measurements in 83 Patients with Bicuspid Aortic Valve and Matched Control Subjects

Hahn RT, Roman MJ, Mugtader AH, Devereux RB, Association of Aortic Dilation with Regurgitant, Stenotic, and Functionally Normal Bicuspid Aortic Valves. J Am Coll Cardiol, 1992 Feb; 19(2):283-8

Bicuspid Aortic Valve - References1) Braverman AC, Hasan G, Beardslee MA, Makan M, Kates, AM, Moon MR. The Bicuspid Aortic Valve. Curr Probl Cardiol 2005 Sep: 471-521.2) Sabet HY, Edwards WD, Tazelaar HD, Daly RC. Congenitally Bicuspid Aortic Valves: A Surgical Pathology Study of 542 Cases (1991 Through 1996) and a Literature Review of 2,715 Additional Cases. Mayo Clin Proc 1999;74:14-26.3) Borger MA, David TE. Management of the Valve and Ascending Aorta in Adults with Bicuspid Aortic Valve Disease. Semin Thoracic Cardiovasc Surg 2005; 17:143-147.4) Hans-H. Sievers, MD, and Claudia Schmidtke, MD, MBA. A classification system for the bicuspid aortic valve from 304 surgical specimens. J Thoracic Cardiovasc Surg 2007 133:1226-33.5) Sabet HY, Edwards WD, Tazelaar HD, Daly RC. Congenitally bicuspid aortic valves: a surgical pathology study of 542 cases. Mayo Clin Proc. 1999;74:14-26.6) Roberts WC. The congenital bicuspid aortic valve. Am J Cardiol. 1970;26:72-83.7) Angelini A, Ho SY, Anderson RH, Devine WA, Zuberbuhler JR, Becker AE, et al. The morphology of the normal aortic valve as compared with the aortic valve having two leaflets. J Thorac Cardiovasc Srg. 1989;98:362-7.8) Hahn RT, Roman MJ, Mugtader AH, Devereux RB, Association of Aortic Dilation with Regurgitant, Stenotic, and Functionally Normal Biscuspid Aortic Valves. J Am Coll Cardiol, 1992 Feb; 19(2):283-8