Two-Dimensional Echocardiographic Features of Bicuspid Aortic Valve

Fowles, Robert E.; Martin, Randolph P.; Abrams, Joshua; Schapira, Jay N.; French, James Weir; Popp, Richard L.

doi:10.1378/chest.75.4.434

Cited by 33 publications

(12 citation statements)

References 13 publications

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“…The results of our study concur with those of Fowles et al,12) who also demonstrated superiority of two-dimensional echocardiographic technique in the detection of bicuspid aortic valve. In their group of patients with angiographically proven stenotic and non-stenotic bicuspid aortic valves, the precise valve anatomy was identified by M-mode echocardiography in 75% of subjects, and by two-dimensional echocardiography in 95% of subjects.12) In our series, two-dimensional echocardiography in the short axis view confirmed the diagnosis of a suspected congenitally bicuspid aortic valve in all patients, in spite of the normal M-mode echocardiogram in each patient.…”

Section: Resultssupporting

confidence: 92%

Superiority of two-dimensional echocardiography in the diagnosis of congenitally bicuspid aortic valve.

et al. 1982

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SUMMARYThis study compares the role of M-mode and two-dimensional echocardiography in the evaluation of the nonstenotic, congenitally bicuspid aortic valve. Ten asymptomatic healthy subjects (age 20-35 years) with a systolic ejection click and short systolic murmur were evaluated. M-mode echocardiograms were entirely normal. The aortic root, diastolic closure line, eccentricity index of the aortic valve, and left ventricular size and function were normal in every subject. The two-dimensional parasternal long axis view of the aortic root was also normal in all patients with bicuspid aortic valves; there were no abnormalities of systolic excursion of the aortic cusps and doming of the aortic valve was absent. Images obtained in the two-dimensional parasternal short axis view of the aortic root at the level of the aortic valve revealed only two cusps, anterior and posterior, in all patients. The classic closure pattern of the normal tricuspid aortic valve forming a "Y" was absent in every subject. Instead, a horizontal closure line along the "X" axis was demonstrated in all patients; changing the angulation of the transducer in various positions did not alter this pattern. All subjects had increased reflectance of echoes along the line of diastolic closure, probably resulting from redundancy of the aortic cusp tissue. We conclude that because of the inability of the M-mode echocardiographic technique to accurately diagnose this condition in the study group, two-dimensional echocardiography should be the technique of choice in the evaluation of patients with a suspected bicuspid aortic valve. Recognition of this condition is important in view of its susceptibility to subacute bacterial endocarditis, aortic stenosis, and regurgitation.

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Section: Resultssupporting

confidence: 92%

Superiority of two-dimensional echocardiography in the diagnosis of congenitally bicuspid aortic valve.

et al. 1982

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“…In addition, recent studies documented the role of training and experience to increase cognitive knowledge and psychomotor skills for echocardiography (31,32). However, with 59.7% the sensitivity of expert re-evaluation still remained below optimal study results (18,22). The most likely explanation for these suboptimal results of our expert re-evaluation was the suboptimal interpretability of images, where multiple factors are known to contribute.…”

Section: Low Sensitivity Of Routine Echocardiographymentioning

confidence: 87%

“…Classical studies of the diagnostic accuracy of TTE suggested a high sensitivity of up to 100% for BAV (18,22). However, these studies were performed at tertiary care centers, with careful selection of patients according to age, adequate image quality, absence of previous surgery © Cardiovascular Diagnosis and Therapy.…”

Section: Low Sensitivity Of Routine Echocardiographymentioning

confidence: 99%

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Diagnostic accuracy study of routine echocardiography for bicuspid aortic valve: a retrospective study and meta-analysis

Hillebrand¹,

Koschyk²,

Hark³

et al. 2017

Cardiovasc. Diagn. Ther.

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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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“…The features of BAV on a TTE include systolic doming, an eccentric closure line in the parasternal long axis views, presence of a single commissural line in the diastolic phase with the occurrence of two cusps and the occurrence of two commisures in the parasternal short axis views [ figure 4] [59,60].…”

Section: Echocardiographymentioning

confidence: 99%