Bicuspid aortic stenosis echocardiogram
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Bicuspid aortic stenosis echocardiogram On the Web |
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American Roentgen Ray Society Images of Bicuspid aortic stenosis echocardiogram |
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Risk calculators and risk factors for Bicuspid aortic stenosis echocardiogram |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S. [2]; Usama Talib, BSc, MD [3]
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 between the preoperative assessment with the post-operative 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
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- Bicuspid Aortic Valve by Transesophageal Echo 5
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- Bicuspid Aortic Valve by Transesophageal Echo 6
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- Bicuspid Aortic Valve by Transesophageal Echo 7
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2008 and Incorporated 2006 ACC/AHA Guidelines for the Management of Patients with Valvular Heart Disease (DO NOT EDIT) [3]
Bicuspid Aortic Valve With Dilated Ascending Aorta (DO NOT EDIT) [3]
| Class I |
| "1. Patients with known bicuspid aortic valves should undergo an initial transthoracic echocardiography to assess the diameters of the aortic root and ascending aorta. (Level of Evidence: B)" |
| "2. Cardiac magnetic resonance imaging or cardiac computed tomography is indicated in patients with bicuspid aortic valves when morphology of the aortic root or ascending aorta cannot be assessed accurately by echocardiography. (Level of Evidence: C)" |
| "3. Patients with bicuspid aortic valves and dilatation of the aortic root or ascending aorta (diameter greater than 4.0 cm)* should undergo serial evaluation of aortic root/ascending aorta size and morphology by echocardiography, cardiac magnetic resonance imaging, or computed tomography on a yearly basis. (Level of Evidence: C)" |
| "4. Surgery to repair the aortic root or replace the ascending aorta is indicated in patients with bicuspid aortic valves if the diameter of the aortic root or ascending aorta is greater than 5.0 cm* or if the rate of increase in diameter is 0.5 cm per year or more. (Level of Evidence: C)" |
| Class IIa |
| "1. Cardiac magnetic resonance imaging or cardiac computed tomography is reasonable in patients with bicuspid aortic valves when aortic root dilatation is detected by echocardiography to further quantify severity of dilatation and involvement of the ascending aorta. (Level of Evidence: B)" |
| “ | * Consider lower threshold values for patients of small stature of either gender. | ” |
Asymptomatic Adults with Aortic Stenosis Secondary to Bicuspid Disease (DO NOT EDIT) [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)" |
Sources
- 2008 ACC/AHA Guidelines incorporated into the 2006 guidelines for the management of patients with valvular heart disease [3]
References
- ↑ 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.
- ↑ Cohn LH, Edmunds LH Jr. Cardiac Surgery in the Adult. McGraw-Hill, 2003.
- ↑ 3.0 3.1 3.2 3.3 Bonow RO, Carabello BA, Chatterjee K; et al. (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. Unknown parameter
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