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==Accuracy of Echocardiography in Determining the Number of Leaflets==
==Accuracy of Echocardiography in Determining the Number of Leaflets==
Echocardiography is not that accurate in distinguishing bicuspid from tricuspid aortic valves. There is a high rate of discordance with the pathologic findings following aortic valve repair<ref>Roberts WC, Vowels TJ, Ko JM. Comparison of interpretations of valve structure between cardiac surgeon and cardiac pathologist among adults having isolated aortic valve replacement for aortic valve stenosis (+/- aortic regurgitation). Am J Cardiol. Apr 15 2009;103(8):1139-45.</ref>.
Echocardiography is not that accurate in distinguishing bicuspid from tricuspid aortic valves. There is a high rate of discordance with the pathologic findings following aortic valve repair <ref>Roberts WC, Vowels TJ, Ko JM. Comparison of interpretations of valve structure between cardiac surgeon and cardiac pathologist among adults having isolated aortic valve replacement for aortic valve stenosis (+/- aortic regurgitation). Am J Cardiol. Apr 15 2009;103(8):1139-45.</ref>.
 
==Echocardiographic Findings in Bicuspid Aortic Valve Disease==
==Echocardiographic Findings in Bicuspid Aortic Valve Disease==
*The short axis view is useful, but doming of valve can best be seen on the [[parasternal long axis]].
*The short axis view is useful, but doming of valve can best be seen on the [[parasternal long axis]].

Revision as of 01:01, 14 April 2012

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S. [2]

Overview

Two dimensional echocardiography plays an important role in the diagnosis of bicuspid aortic stenosis. Bicuspid aortic stenosis is important to diagnose because of the associated risk of endocarditis and the risk of progressive valvular stenosis.

Accuracy of Echocardiography in Determining the Number of Leaflets

Echocardiography is not that accurate in distinguishing bicuspid from tricuspid aortic valves. There is a high rate of discordance with the pathologic findings following aortic valve repair [1].

Echocardiographic Findings in Bicuspid Aortic Valve Disease

  • The short axis view is useful, but doming of valve can best be seen on the parasternal long axis.
  • Echocardiographic features that are associated with a poor prognosis in asymptomatic patients and progression to a symptomatic state include moderate to severe calcification and a peak aortic velocity > 4.0 M/s. [2]


  • Bicuspid Aortic Valve by Transesophageal Echo 1

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  • Bicuspid Aortic Valve by Transesophageal Echo 2

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  • Bicuspid Aortic Valve by Transesophageal Echo 3

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  • Bicuspid Aortic Valve by Transesophageal Echo 4

{{#ev:googlevideo|3670690104304937807&hl=en}}

  • Bicuspid Aortic Valve by Transesophageal Echo 5

{{#ev:googlevideo|2955895618088483909&hl=en}}

  • Bicuspid Aortic Valve by Transesophageal Echo 6

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  • Bicuspid Aortic Valve by Transesophageal Echo 7

{{#ev:googlevideo|-1456550005760918044&hl=en}}

ACC/AHA Guidelines for Echocardiographic Evaluation and Monitoring of Asymptomatic Adults with Aortic Stenosis Secondary to Either Bicuspid or Degenerative Tricuspid Disease[3]

Class I

1. Doppler echocardiography is recommended yearly in the asymptomatic adolescent or young adult with AS who has a Doppler mean gradient greater than 30 mm Hg or a peak velocity > 3.5 m per second (peak gradient > 50 mm Hg) and every 2 years if the Doppler gradient is ≤ 30 mm Hg or the peak jet velocity is ≤ 3.5 m per second (peak gradient ≤ 50 mm Hg). (Level of Evidence: C)

2. Transthoracic echocardiography is recommended for re-evaluation of asymptomatic patients: every year for severe AS; every 1 to 2 years for moderate AS; and every 3 to 5 years for mild AS. (Level of Evidence: B)

References

  1. Roberts WC, Vowels TJ, Ko JM. Comparison of interpretations of valve structure between cardiac surgeon and cardiac pathologist among adults having isolated aortic valve replacement for aortic valve stenosis (+/- aortic regurgitation). Am J Cardiol. Apr 15 2009;103(8):1139-45.
  2. Cohn LH, Edmunds LH Jr. Cardiac Surgery in the Adult. McGraw-Hill, 2003.
  3. Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O'Gara PT, O'Rourke RA, Otto CM, Shah PM, Shanewise JS (2008). "2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 118 (15): e523–661. doi:10.1161/CIRCULATIONAHA.108.190748. PMID 18820172. Retrieved 2012-04-11. Unknown parameter |month= ignored (help)

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