The American Association for Thoracic Surgery consensus guidelines on bicuspid aortic valve–related aortopathy: Full online-only version

Borger, Michael A.; Fedak, Paul W.M.; Stephens, Elizabeth H.; Gleason, Thomas G.; Girdauskas, Evaldas; Ikonomidis, John S.; Khoynezhad, Ali; Siu, Samuel C.; Verma, Subodh; Hope, Michael D.; Cameron, Duke E.; Hammer, Donald; Coselli, Joseph S.; Moon, Marc R.; Sundt, Thoralf M.; Barker, Alex J.; Markl, Michael; Corte, Alessandro Della; Michelena, Héctor I.; Elefteriades, John A.

doi:10.1016/j.jtcvs.2018.02.115

Cited by 218 publications

(227 citation statements)

References 249 publications

(404 reference statements)

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“…Bicuspid aortic valve (BAV) is present in 1-2% of the population; almost 40% also have thoracic aortic dilatation at the time of presentation [18].…”

Section: Bicuspid Aortic Valvementioning

confidence: 99%

Aortic Root Reconstruction

Altarabsheh¹,

Deo²,

Elgudin³

2020

Cardiac Surgery Procedures

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Aortic root reconstruction represents one of the most complex areas of cardiac surgery as well as one of the most dynamic-major developments in understanding of the aortic root anatomy and physiology, improvements in imaging and surgical technique allowed for development and acceptance into clinical practice of several novel procedures over last couple of decades. From first aortic root replacement reported by Bentall and De Bono in 1968 to aortic root reimplantation (David procedure) and remodeling (Yacoub operation) with multiple contemporary modifications, aortic root reconstruction now is widely used in treatment of chronic aortic aneurysmal disease and acute aortic dissections alike. Basic principles of aortic root structure and function and critical operative strategies for aortic root surgery are reviewed in this chapter.

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“…Bicuspid aortic valve (BAV) is present in 1-2% of the population; almost 40% also have thoracic aortic dilatation at the time of presentation [18].…”

Section: Bicuspid Aortic Valvementioning

confidence: 99%

Aortic Root Reconstruction

Altarabsheh¹,

Deo²,

Elgudin³

2020

Cardiac Surgery Procedures

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“…With a prevalence of approx. 1000 -2000/100 000, bicuspid aortic valve disease is the most common cardiovascular malformation [49]. There is a polygenetic inheritance pattern with variable penetrance frequently associated with mutations of the NOTCH1 signaling pathway.…”

Section: Bicuspid Aortic Valve Diseasementioning

confidence: 99%

“…There is a polygenetic inheritance pattern with variable penetrance frequently associated with mutations of the NOTCH1 signaling pathway. The inheritance pattern is not yet known [49].…”

Section: Bicuspid Aortic Valve Diseasementioning

confidence: 99%

“…Dilatation of the ascending aorta can occur in accompanying aortic valve stenosis as well as insufficiency [55]. However, an aneurysm or dissection can form even without stenosis or insufficiency of the bicuspid aortic valve [49,52]. In addition to a persistent ductus arteriosus, coronary anomalies and brain aneurysms, an aortic isthmus stenosis can also be associated with a bicuspid aortic valve [49,56].…”

Section: Bicuspid Aortic Valve Diseasementioning

confidence: 99%

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Current and Emerging Imaging Techniques in Patients with Genetic Aortic Syndromes

Weinrich

Lenz

Girdauskas³

et al. 2019

Fortschr Röntgenstr

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Background Patients with genetic aortic syndromes such as Marfan or Loeys-Dietz syndrome have a decreased life expectancy due to the risk of aortic dissection and rupture. Imaging plays an important role in the acute setting but also in the initial diagnosis and image-based monitoring. In this article, we provide an overview of the most common genetic aortic syndromes and recommended imaging strategies. Furthermore, we highlight modern imaging methods allowing for the quantification of hemodynamic changes in aortic disease. Method This is a narrative review article on genetic aortic syndromes and recommended imaging strategies, where we take into account expert opinions and standard-of-care practices from our own center. Results and Conclusion Radiological imaging plays a key role in the initial diagnosis and surveillance of patients with genetic aortic syndromes. Radiologists contribute significantly to the multi-disciplinary setting of genetic aortic syndromes with knowledge of special features and recommended imaging methods. Accurate measurement of the aorta is crucial, particularly in terms of diameter-based surgical treatment algorithms. Modern imaging methods like 4D-flow MRI and pulse wave velocity have a potential to further improve individualized risk stratification in patients with genetic aortic syndromes. Key points: Citation Format

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“…Bicuspid aortic valve (BAV) is the most prevalent adult congenital heart defect . BAV causes lifelong progressive disease that is responsible for more than half of aortic valve replacement surgeries in adults and predisposes to a greatly increased prevalence of aortic aneurysms and acute aortic dissections . A transthoracic echocardiogram (TTE) should be performed at diagnosis to assess valve function and to screen for thoracic aortopathy or other congenital defects, such coarctation, which frequently occur with BAV.…”

Section: Introductionmentioning

confidence: 99%

Misclassification of bicuspid aortic valves is common and varies by imaging modality and patient characteristics

Cramer¹,

Prakash²

2019

Echocardiography

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Background Bicuspid aortic valve (BAV) is the most prevalent adult congenital heart defect. BAV causes lifelong progressive disease that can be prevented by early diagnosis and long‐term surveillance, but may be compromised by misclassification of valve morphology. Methods The study population was derived from the UTHealth Bicuspid Aortic Valve Registry, which includes serial images on more than 200 participants over a mean follow‐up interval of 2.8 years. We abstracted descriptions of aortic valve morphology from transthoracic or transesophageal echocardiography, computed tomography angiography, and magnetic resonance angiography reports. We used chi‐square and t tests to determine associations between reported valve morphologies (definitely bicuspid, possibly bicuspid, tricuspid, or uncertain) and clinical characteristics and assessed image quality using a validated tool. Results About 40% of participants were misclassified in at least one imaging report. The mean interval between misclassification and correct diagnosis was 22 months. TEE, MR and CT were more sensitive than TTE and successfully reclassified 20% of participants, but were only used in 14% of patients. Misclassification was associated with age, the extent of valve calcification and image quality, but was not significantly associated with aortic regurgitation, gender, or cusp configuration. Conclusion Misclassification of BAV is prevalent, frequently leads to delayed diagnosis, and is more likely to occur in the most severely affected cases. TEE, CT and MR may increase diagnostic accuracy in up to half of BAV cases but are underutilized. Additional studies are needed to determine if misclassification of BAV patients leads to increased long‐term morbidity and mortality.

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The American Association for Thoracic Surgery consensus guidelines on bicuspid aortic valve–related aortopathy: Full online-only version

Cited by 218 publications

References 249 publications

Aortic Root Reconstruction

Aortic Root Reconstruction

Current and Emerging Imaging Techniques in Patients with Genetic Aortic Syndromes

Misclassification of bicuspid aortic valves is common and varies by imaging modality and patient characteristics

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