Children and adults with a bicuspid aortic valve need regular doctor's checkups and echocardiograms to check for leaking regurgitation or stiffening stenosis of the valve or an enlarged aorta. Treatment depends on the extent of heart valve disease.
There are no medications to treat a bicuspid heart valve. However, your doctor may prescribe drugs to treat related heart problems such as high blood pressure.
You may need surgery for aortic valve stenosis, aortic valve regurgitation or an enlarged aorta. In biological valve replacement, a valve made from cow, pig or human heart tissue replaces the damaged valve.
In mechanical valve replacement, a mechanical valve replaces the damaged valve. Surgery may be needed to repair or replace the aortic valve. The type of surgery done depends on your specific condition and symptoms. Aortic valve replacement. The surgeon removes the damaged valve and replaces it with a mechanical valve or a valve made from cow, pig or human heart tissue biological tissue valve.
Another type of biological tissue valve replacement that uses your own pulmonary valve is sometimes possible. Biological tissue valves break down over time and may eventually need to be replaced. People with mechanical valves will need to take blood thinners for the rest of their lives to prevent blood clots.
Your doctor will discuss with you the benefits and risks of each type of valve and discuss which valve may be appropriate for you. After a bicuspid aortic valve has been diagnosed, you'll need lifelong doctor's checkups by a cardiologist to monitor for any changes in your condition.
If you have a bicuspid aortic valve, you are more likely to develop an infection of the lining of the heart infective endocarditis. Furthermore, the different anatomy has apparent implications for tissue quality [ 19 , 20 ]. The significant difference in the age of the patients between TAV and BAV in this study can be explained by the different aetiology of the chronic AR [ 19 ], which is concordant with previous findings [ 4 ].
The comparison of the echocardiographic dimensions according to size showed that the majority of parameters were larger in TAV. This is, however, contradictory to previous knowledge which states that the aortic root containing a BAV is larger and more prone to dilatation, even more so in regurgitant BAV [ 21 ].
Similar findings were described in a sample of mildly regurgitant bicuspid valves [ 22 ] but as our design did not include studies of elasticity or distensibility it does not allow any conclusions in this aspect. Since we did not find any general dilatation of the aorta in the BAV group the haemodynamically significant AR might be a forerunner and even the cause of imminent dilatation. The larger aortic dimension in AR TAV and the increased aortic wall compliance of the BAV compared with previously studied healthy valves are notable [ 14 ].
These two findings might indicate a selection bias due to exclusion of patients with ascending aortic aneurysm. This is a finding that followed the pattern of normal aortic root previously studied by our group [ 14 ] and it supports previous findings made in healthy subjects stating that the VAJ is a separate entity not under the influence of the aorta and should be considered and treated as such.
It seems logical to assume it to be under the influence of structures and physiological events in the left ventricle when it is not under aortic influence [ 6 , 14 , 23 ], but that is beyond the scope of this study. The position of the observed raphe between the left and right coronary cusp and the disparity of the cusps in this study represented the most common pattern for BAV. This is in concordance with the findings of Sabet et al.
Despite our modest number of subjects, this correlated well with the findings for the type of regurgitation. In our patients, the most common type of regurgitation in BAV was Type 2 leading us to the conclusion that the conjoined cusps in the posterior cusp in BAV usually have excessive leaflet tissue. The results of visual observation of unequal cusps in BAV were confirmed by the statistical comparison of IC distances.
Enlargement of the aortic root with normal cusps Type 1 and excessive tissue, cusp prolapse or fenestration Type 2 are candidates for valve-sparing surgery while Type 3 regurgitation due to poor cusp tissue quality or quantity is associated with adverse outcome and more often in need of reoperation, resulting in AVR [ 5 ]. In the same study, there were a number of valves classified as repairable, Type 1 or 2 regurgitations, which were operated on with valve-sparing techniques which needed reoperation.
These valves were suspected of being actually Type 3 regurgitations wrongfully classified visually as repairable by the surgeon. These valves may in the future be classified as probably unrepairable based on an extensive echocardiographic examination incorporated in the process of decision complementing the surgeons' visual examination. The regurgitation mechanisms in our study were evenly distributed in TAV, but with an overrepresentation of prolapsing valves in BAV corresponding well with our findings of excessive leaflet tissue in BAV.
Our echocardiographic description has the potential to provide additional knowledge prior to intervention, thereby increasing the understanding of both the echocardiographic anatomy of the regurgitant aortic valve and the possible mechanism of the regurgitation. Some measurements are not even possible to compare between the two modalities because of their built-in limitations.
Concerning the regurgitant aortic valve, 3D TEE is validated as a superior method of measuring regurgitant volumes and effective regurgitant orifice area [ 25 ]. Real-time 3D TEE examination can today be performed with an acceptable frame rate.
However, although 3D visualization provides valuable information on spatial relationships and may aid in the determination of regurgitation mechanisms, due to its even higher frame rate and spatial resolution, 2D TEE still has a place in the diagnostics of aortic valve pathology based on its accuracy, which is needed to expose delicate structures such as the aortic valve leaflets.
Hence, 2D TEE can form the basis of clinical decision making regarding morphology of the regurgitant aortic valve for some time yet, and constitute a possible benchmark for future 3D studies. The fact that all but one of the BAV showed the same raphe position and IC relations limits the generalizability of the findings in this study. However, the one presented here is still the most common pattern and only less frequent dispositions are absent.
Thus, the conclusions still can be considered representative for the majority of the BAV population. All the patients in this study happened to be men, which consequently does not allow conclusions to be drawn for women though studying gender aspects of the morphology of the regurgitant aortic valve was not part of the study design and, therefore, beyond the scope of this study.
The gender distribution in purely regurgitant BAV was described earlier as Furthermore, the small number of patients in this study is balanced by non-parametric analyses of the data to enhance generalizability.
In conclusion, the detailed 2D TEE measurements of this study can add further important information to our knowledge about the function and echocardiographic anatomy of the pathological aortic valve and root as a stand-alone examination or as a benchmark and complement to 3D echocardiography. This could have an impact on planning the type of aortic valve intervention.
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When the ventricles contract, the mitral and tricuspid valves close while the blood is pumped outward through the pulmonary and aortic valves to the lungs and body. The bundle branches are a part of the electrical system of the heart. The electrical system controls the heartbeat and…. The bundle of His is a part of the electrical system of the heart.
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