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Brain & Heart Modern imaging and management of bicuspid valves

Figure 2. Acute severe aortic regurgitation with a short pressure half time of 68 ms on echocardiography, apical 5-chamber view

932 excised aortic valves, 504 (54%) were congenitally
malformed (unicuspid in 46 and bicuspid in 558).
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Another recent single-center study from the Mayo Clinic,
which looked at all surgically excised aortic valves between
January 1, 2000, and June 15, 2023, found that BAV
accounted for almost 30% of all excised valves. Among
the excised valves, 31% of stenotic and 37% of mixed
stenotic and regurgitant aortic valves were bicuspid. The
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pathophysiology of stenosis appears to be similar in both
tricuspid and BAVs. Calcification initially starts on the
aortic side of the leaflet, accompanied by inflammatory
cell infiltration (macrophage and T lymphocyte) and
lipoprotein oxidation. These changes and fibrosis lead
to leaflet stiffening and motion restriction, eventually
Figure 3. Dilated ascending aorta on computed tomography angiography 16
axial slice associated with bicuspid aortic valve impairing systolic valve opening as the disease advances.
When stenotic dysfunction begins, it typically progresses at
identified, and screening the entire population is not a similar rate in both tricuspid and BAV. However, stenotic
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feasible from both a resource and time perspective. When BAVs tend to occur almost a decade earlier. Aortic
compared to a prevalence of 0.8% for all other congenital regurgitation (AR) is also a well-known complication of
heart diseases, BAV poses a significant burden to the BAV; several studies have reported varying percentages of
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health system on a national scale, as serious complications AR prevalence in BAV patients. Numbers in the literature
occur in at least 33% of cases. In terms of mortality and vary in terms of clinically significant AR among BAV
morbidity, BAV alone exceeds the collective impact of all patients. In their cohort of 1,890 patients with BAV, Masri
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other congenital heart defects combined. 6 et al. found that 31% of patients had a New York Heart
Association class ≥III AR. The mean age of patients within
2.3. Clinical presentation this subgroup was significantly lower than that for patients
The clinical presentation of patients with BAV can vary with severe AS (45 ± 13 versus 54 ± 12 years, respectively;
from asymptomatic and detected on screening or as an p<0.001). 21
incidental finding of cardiac imaging, up to severe valve Infective endocarditis (IE) is more common in patients
disease with symptoms or aortopathy from infancy to old with BAV when compared to the general population. In a
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age. Symptoms typically emerge late in adulthood when recent study published in the European Heart Journal, Yang
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stenosis develops because of the superimposed leaflet et al. have found that patients with BAV have a 6% lifetime
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calcification. Hence, the majority of patients (68.5% of risk of developing IE. Older studies have suggested the
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patients) with BAV will eventually require intervention use of IE antibiotic prophylaxis; however, due to the lack
during their lifetime. 16,17 of solid data, the American Heart Association (AHA) in
AS is known to be the most common complication of 2007 and the European Society of Cardiology in 2009
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BAV in cases requiring aortic valve replacement (AVR). restricted the use of IE antibiotic prophylaxis in patients
6
Roberts and Ko have previously found that among with BAV as the only risk factor for IE.
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Volume 3 Issue 3 (2025) 3 doi: 10.36922/BH025050008