https://doi.org/10.4081/monaldi.2023.2761

Unlocking insights in bicuspid aortic valve management in adult patients: the vital role of cardiac imaging

Vol. 94 No. 1 (2024)
Published: September 15, 2023
Bicuspid aortic valve, imaging, echocardiography, morphology, outcome
Abstract Views: 744
PDF: 401
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Authors

Sara Di Michele
https://orcid.org/0000-0003-0163-3312
Department of Cardiology, San Filippo Neri Hospital, Rome, Italy.
Vito Maurizio Parato
Cardiology and Rehabilitation Unit, Emergency Department, San Benedetto del Tronto, Italy.
Giovanna Di Giannuario
https://orcid.org/0000-0002-5580-8651
Department of Cardiology, Infermi Hospital, Rimini, Italy.
Naji Kholaif
https://orcid.org/0009-0003-6914-0730
Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Mohammed Al Admawi
Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Saif Aljheish
Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Lana Arbili
larbili@alfaisal.edu
https://orcid.org/0000-0002-4725-4214
College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
Amal Alshammari
https://orcid.org/0000-0001-5845-8346
Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Andrea Giovanni Parato
https://orcid.org/0009-0000-2342-0233
Department of Cardiology, Tor Vergata University, Rome, Italy.
Hani Al Sergani
Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.

The bicuspid aortic valve (BAV) presents a multifaceted clinical challenge due to its diverse morphologies and associated complications. This review aims to elucidate the critical role of cardiac imaging in guiding optimal management strategies for BAV patients. BAV, with a prevalence of 1-2%, has genetic underpinnings linked to the NOTCH1 gene mutation. Variability in BAV morphology necessitates tailored surgical approaches. The three primary types of BAV morphology - right-left cusp fusion, right-noncoronary cusp fusion, and left-noncoronary cusp fusion - demand nuanced considerations due to their distinct implications. Valvular dysfunction results in aortic stenosis or regurgitation, attributed to altered valve structure and turbulent hemodynamics. Cardiac imaging modalities, including echocardiography, magnetic resonance imaging, and computerized tomography, are instrumental in assessing valve function, aortic dimensions, and associated complications. Imaging helps predict potential complications, enabling informed treatment decisions. Regular follow-up is crucial to detecting alterations early and intervening promptly. Surgical management options encompass aortic valve repair or replacement, with patient-specific factors guiding the choice. Post-surgical surveillance plays a vital role in preventing complications and optimizing patient outcomes. The review underscores the significance of advanced cardiac imaging techniques in understanding BAV's complexities, facilitating personalized management strategies, and improving patient care. By harnessing the power of multimodal imaging, clinicians can tailor interventions, monitor disease progression, and ultimately enhance the prognosis and quality of life for individuals with BAV.

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Scopus
Google Scholar
Europe PMC
Michelena HI, Della Corte A, Evangelista A, et al. International consensus statement on nomenclature and classification of the congenital bicuspid aortic valve and its aortopathy, for clinical, surgical, interventional and research purposes. J Thorac Cardiovasc Surg 2021;162:e383-e414.
Bravo-Jaimes K, Prakash SK. Genetics in bicuspid aortic valve disease: where are we? Prog Cardiovasc Dis 2020;63:398-406.
Yoon SH, Kim WK, Dhoble A, et al. Bicuspid aortic valve morphology and outcomes after transcatheter aortic valve replacement. J Am Coll Cardiol 2020;76:1018-30.
Chen J, Lu S, Hu K, et al. Clinical characteristics and surgical treatment of infective endocarditis with bicuspid aortic valve. Int Heart J 2017;58:220-4.
Fernández B, Soto-Navarrete MT, López-García A, et al. Bicuspid aortic valve in 2 model species and review of the literature. Vet Pathol 2020;57:321-31.
Xiong TY, Ali WB, Feng Y, et al. Transcatheter aortic valve implantation in patients with bicuspid valve morphology: a roadmap towards standardization. Nat Rev Cardiol 2023;20:52-67.
Verma R, Cohen G, Colbert J, Fedak PWM. Bicuspid aortic valve associated aortopathy: 2022 guideline update. Curr Opin Cardiol 2023;38:61-7.
Tarantini G, Fabris T, Nai Fovino L, et al. Definition of trAnscatheter heart Valve orIeNtation in biCuspId aortic valve: The DA VINCI pilot study. Front Cardiovasc Med 2022;9:1056496.
Katz M, Mazin I, Kuperstein R, et al. Bicuspid aortic valve area in normal heart. Echocardiography 2020;37:439-44.
D'Ascenzi F, Valentini F, Anselmi F, et al. Bicuspid aortic valve and sports: from the echocardiographic evaluation to the eligibility for sports competition. Scand J Med Sci Sports 2021;31:510-20.
Shen M, Oh JK, Guzzetti E, et al. Computed tomography aortic valve calcium scoring in patients with bicuspid aortic valve stenosis. Struct Heart 2022;6:100027.
Santarpia G, Scognamiglio G, Di Salvo G, et al. Aortic and left ventricular remodeling in patients with bicuspid aortic valve without significant valvular dysfunction: a prospective study. Int J Cardiol 2012;158:347-52.
Murphy IG, Collins J, Powell A, et al. Comprehensive 4-stage categorization of bicuspid aortic valve leaflet morphology by cardiac MRI in 386 patients. Int J Cardiovasc Imaging 2017;33:1213-21.
Kang JW, Song HG, Yang DH, et al. Association between bicuspid aortic valve phenotype and patterns of valvular dysfunction and bicuspid aortopathy: comprehensive evaluation using MDCT and echocardiography. JACC Cardiovasc Imaging 2013;6:150-61.
Sinning C, Zengin E, Kozlik-Feldmann R, et al. Bicuspid aortic valve and aortic coarctation in congenital heart disease-important aspects for treatment with focus on aortic vasculopathy. Cardiovasc Diagn Ther 2018;8:780-8.
Erbel R, Aboyans V, Boileau C, et al. 2014 ESC guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The task force for the diagnosis and treatment of aortic diseases of the European Society of Cardiology (ESC). Eur Heart J 2014;35:2873-26.
Della Corte A, Romano G, Tizzano F, et al. Echocardiographic anatomy of ascending aorta dilatation: correlations with aortic valve morphology and function. Int J Cardiol 2006;113:320-6.
Girdauskas E, Rouman M, Borger MA, Kuntze T. Comparison of aortic media changes in patients with bicuspid aortic valve stenosis versus bicuspid valve insufficiency and proximal aortic aneurysm. Interact Cardiovasc Thorac Surg 2013;17:931-6.
Sophocleous F, Biffi B, Milano EG, et al. Aortic morphological variability in patients with bicuspid aortic valve and aortic coarctation. Eur J Cardiothorac Surg 2019;55:704-13.
Di Salvo G, Bulbul Z, Pergola V, et al. Gothic aortic arch and cardiac mechanics in young patients after arterial switch operation for d-transposition of the great arteries. Int J Cardiol 2017;241:163-7.
Kocabay G, Karabay CY, Kalkan S, et al. Relationship between left ventricular diastolic function and arterial stiffness in patients with bicuspid aortic valve. J Heart Valve Dis 2014;23:279-88.
Bilen E, Akçay M, Bayram NA, et al. Aortic elastic properties and left ventricular diastolic function in patients with isolated bicuspid aortic valve. J Heart Valve Dis 2012;21:189-94.
Demir M. Left ventricular systolic and diastolic function in subjects with a bicuspid aortic valve without significant valvular dysfunction. Exp Clin Cardiol 2013;18:e1-4.
Bech-Hanssen O, Al-Habeeb W, Ahmed W, et al. Echocardiography detects elevated left ventricular filling pressures in heart transplant recipients. Echocardiography 2015;32:411-9.
Jasinski MJ, Miszalski-Jamka K, Kosiorowska K, et al. The evaluation of annuloplasty in bicuspid aortic valve repair using cardiac magnetic resonance. BMC Cardiovasc Disord 2021;21:13. Erratum in: BMC Cardiovasc Disord 2021;21:89.
Hanigk M, Burgstaller E, Latus H, et al. Aortic wall shear stress in bicuspid aortic valve disease-10-year follow-up. Cardiovasc Diagn Ther 2023;13:38-50.
Rodrigues I, Agapito AF, de Sousa L, et al. Bicuspid aortic valve outcomes. Cardiol Young 2017;27:518-29.
Evangelista Masip A, Galian-Gay L, Guala A, et al. Unraveling bicuspid aortic valve enigmas by multimodality imaging: clinical implications. J Clin Med 2022;11:456.
Galian-Gay L, Rodríguez-Palomares J, Guala A, et al. Multimodality imaging in bicuspid aortic valve. Prog Cardiovasc Dis 2020;63:442-51.
Kong WKF, Vollema EM, Prevedello F, et al. Prognostic implications of left ventricular global longitudinal strain in patients with bicuspid aortic valve disease and preserved left ventricular ejection fraction. Eur Heart J Cardiovasc Imaging 2020;21:759-67.
Van den Hoven AT, Yilmazer S, Chelu RG, et al. Left ventricular global longitudinal strain in bicupsid aortic valve patients: head-to-head comparison between computed tomography, 4D flow cardiovascular magnetic resonance and speckle-tracking echocardiography. Int J Cardiovasc Imaging 2020;36:1771-80.
Yammine M, Williams E, El-Hamamsy I. The Ross procedure for bicuspid aortic valve: total root implantation technique. Ann Cardiothorac Surg 2022;11:484-6.
Sharabiani MT, Dorobantu DM, Mahani AS, et al. Aortic valve replacement and the Ross operation in children and young adults. J Am Coll Cardiol 2016;67:2858-70.
Pergola V, Di Salvo G, Fadel B, et al. The long term results of the Ross procedure: the importance of candidate selection. Int J Cardiol 2020;320:35-41.
Khan SM, Sallehuddin AB, Al-Bulbul ZR, Al-Halees ZY. Neoaortic bicuspid valve in arterial switch operation: mid-term follow-up. Ann Thorac Surg 2008;85:179-84.
Hardikar AA, Marwick TH. Surgical thresholds for bicuspid aortic valve associated aortopathy. JACC Cardiovasc Imaging 2013;6:1311-20.
Tchetche D, de Biase C, van Gils L, et al. Bicuspid aortic valve anatomy and relationship with devices: the BAVARD multicenter registry. Circ Cardiovasc Interv 2019;12:e007107.
Ueshima D, Nai Fovino L, Brener SJ, et al. Transcatheter aortic valve replacement for bicuspid aortic valve stenosis with first- and new-generation bioprostheses: a systematic review and meta-analysis. Int J Cardiol 2020;298:76-82.

How to Cite

Di Michele, Sara, Vito Maurizio Parato, Giovanna Di Giannuario, Naji Kholaif, Mohammed Al Admawi, Saif Aljheish, Lana Arbili, Amal Alshammari, Andrea Giovanni Parato, and Hani Al Sergani. 2023. “Unlocking Insights in Bicuspid Aortic Valve Management in Adult Patients: The Vital Role of Cardiac Imaging”. Monaldi Archives for Chest Disease 94 (1). https://doi.org/10.4081/monaldi.2023.2761.
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