Page 32 - BH-3-3

Brain & Heart Modern imaging and management of bicuspid valves

handle. Children and adolescents with mild isolated BAV aortic diameter should be inversely proportional. This can
usually have very little and slow disease progression before sometimes prevent athletes from practicing in sports. 132
adulthood and do not need treatment. On the other
120
hand, when even mild changes in valvular status become 7. Conclusion
present, it can cause aortic dilation to become 9 times Multi-modality imaging is very important in managing
more prevalent. Children with BAV have lower rates BAV as it involves evaluating valve morphology, valve
121
of complications, including dissections and interventions function, and associated aortic pathologies. The initial
for valvular dysfunction. However, despite the low diagnosis and functional evaluation of the valve is usually
frequency of complications, children and adolescents done by echocardiography, whereas cardiac MRI and CT
with BAV should be followed frequently to make sure no are used for enhanced anatomical analysis and surgical
complications go unnoticed. 120,122,123 Children with BAV decision-making. The integration of these imaging
and normal aortic parameters do not have any restrictions modalities has improved diagnosis, risk assessment,
for exercise, as regular exercise does not seem to be an management, and follow-up, thus enabling a more specific
independent risk factor for progression. BAV in children management approach. Further research is necessary for
124
may be regurgitant or stenotic, just like adults, and surgery increasing our understanding of the roles of genetic and
is often the therapeutic option of choice, especially for environmental factors in BAV, advancing multi-modality
the regurgitant subtype. The optimal initial step for imaging evaluation of these conditions, and developing
100
managing stenotic BAV is still controversial, especially optimal transcatheter approaches to treating BAV disease
with opinions advocating balloon valvuloplasty, as it has and thoracic aortic aneurysms, and comparing these
been gaining popularity over the recent years, with AS ideally in randomized trials to conventional aortic valve
becoming more common than AR in neonates and infants and aortic surgeries.
with BAV. 125-127
Acknowledgments
6.3. BAV in the elderly
None.
Elderly patients with BAV are not a special population
concerning presentation. They are patients who have Funding
been asymptomatic throughout their lives and have now
presented with signs of valvular dysfunction. Treatment None.
suggested for this population is AVR and/or aortic surgery, Conflict of interest
depending on the diameter of the aorta. However, what
3
makes the elderly a special population is the treatment of The authors declare they have no competing interests.
choice. Making the decision between SAVR or TAVR in this
subgroup is particularly important, as numerous factors Author contributions
must be considered. The heart team should collaborate Conceptualization: Faysal Massad, Tom Kai Ming Wang
with the patient to make an informed decision. Compared Visualization: Faysal Massad, Simrat Kuaur, Tom Kai Ming
to SAVR, TAVR has a lower rate of reintervention, and after Wang
TAVR failure, surgical repair is a very probable option. If Writing – original draft: Faysal Massad, Ahmad Safdar,
SAVR is performed first, patients will have a longer time Elio Haroun, Aro Daniela Arockiam, Mahmoud
to undergo reintervention, and they will always have the Alshneikat, Simrat Kaur, Tom Kai Ming Wang
possibility of undergoing a Valve-in-Valve procedure. 128-130 Writing – review & editing: Faysal Massad, Elio Haroun,
6.4. BAV in athletes Akiva Rosenzveig, Mahmoud Alshneikat, Tom Kai
Ming Wang
Multiple studies have shown that aortic measurements for
BAV patients in athletic and non-athletic individuals are Ethics approval and consent to participate
similar. In longer-term studies, athletes with BAV have Not applicable.
had a benign course, probably independent progression
of aortic dilation, AS, and AR, regardless of the patient’s Consent for publication
physical activity. 2,131 Thus, athletes with BAV and no
aortopathy should be treated similarly to patients with Not applicable.
tri-leaflet valvular dysfunction with regard to exercise Availability of data
recommendations. On the other hand, if BAV is complicated
by aortopathy, the relationship between exercise and Not applicable.

Volume 3 Issue 3 (2025) 13 doi: 10.36922/BH025050008