Presented at: American College of Cardiology Scientific Session; March 17-19, 2017; Washington, D.C. Yoon SH, et al. J Am Coll Cardiol. 2017;doi:10.1016/j.jacc.2017.03.017. Disclosure: Yoon reports no relevant financial disclosures. [healio.com]

Its demonstration also depends on the beam orientation and is only present in 50% of cases. [jpgmonline.com]

Abstract We herein present a rare case of severe aortic valve stenosis with a bicuspid valve in a patient with systemic lupus erythematosus. [link.springer.com]

Conclusions Male patients with BAV present more frequently with moderate AR at first presentation whereas female present more frequently with moderate AS. Furthermore, diffuse dilatation of the aorta was more prevalent in male. [onlinejacc.org]

Cystic medial necrosis present in the aneurysmal wall probably arose as a consequence of poststenotic dilatation. Adequate noninvasive evaluation of the ascending aorta requires echocardiographic studies, as well as a chest X-ray film. [jhu.pure.elsevier.com]

• Coarctation of the Aorta

  THIS IS CASE 4,555 OF 4,932 JUMP TO CASE 4,554 Coarctation of the Aorta with Dilated Left Subclavian Artery 4,553 Type A Dissection Nicely Seen with Gated Acquisition CURRENT CASE Bicuspid valve with Extensive Calcification and Aortic Stenosis 4,556 Pericardial [ctisus.com]

  The bicuspid aortic valve is associated with abnormalities of the aortic wall such as coarctation of the aorta, aortic dissection, and aortic aneurysm. Most patients with a bicuspid aortic valve will develop some complication during life. [ncbi.nlm.nih.gov]

  This arrangement is much more common in patients with coarctation of the aorta, whose valves function adequately. [emedicine.medscape.com]

  […] of the aorta. [1] Pathophysiology of Aortic Stenosis The pathophysiology of aortic stenosis is described in the main chapter on the pathophysiology of aortic stenosis here. [wikidoc.org]

• Hunting

  الصفحة 108 - Hunt SA, Baker DW, Chin MH, et al. [books.google.com]

  DOI: 10.1016/j.jacc.2008.05.007 PubMed ID: 18848134 HubMed Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, Del Nido P, Fasules JW, Graham TP Jr, Hijazi ZM, Hunt SA, King ME, Landzberg MJ, Miner PD, Radford MJ, Walsh EP, and Webb [textbookofcardiology.org]

  Carabello BA, Chatterjee K, de Leon AC Jr, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O'Gara PT, O'Rourke RA, Otto CM, Shah PM, Shanewise JS, Smith SC Jr, Jacobs AK, Adams CD, Anderson JL, Antman EM, Fuster V, Halperin JL, Hiratzka LF, Hunt [medsci.org]

• Heart Disease

  Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. ‏ [books.google.com]

  An echocardiographic study of valvular heart disease associated with systemic lupus erythematosus. N Engl J Med 1996; 335: 1424–30. PubMed CrossRef Google Scholar 8. Sabet HY, Edwards WD, Tazelaar HD, Daly RC. [link.springer.com]

  Still, in developing countries, rheumatic heart disease remains the most common cause of valvular heart disease. [textbookofcardiology.org]

  Session Title: Valvular Heart Disease: AV - Bicuspid/Gender; Low Gradient/Preserved EF Abstract Category: 40. Valvular Heart Disease: Clinical Presentation Number: 1193M-01 2016 American College of Cardiology Foundation [onlinejacc.org]

  […] defect (Medical Encyclopedia) [ Read More ] Heart Valve Diseases Also called: Valvular heart disease Your heart has four valves. [icdlist.com]

• Heart Murmur

  The main sign of heart valve disease is an unusual heartbeat sound called a heart murmur. Your doctor can hear a heart murmur with a stethoscope. But many people have heart murmurs without having a problem. [icdlist.com]

  A heart murmur was noted during that consultation but not followed up. He later recalled that as a child he underwent annual review for a heart murmur. At age 16 he was reassured and discharged from clinic. [bmj.com]

  Get your heart murmur checked People with heart murmurs are at an increased risk of an aortic valve disease called bicuspid aortic valve disease. [pennmedicine.org]

  A patient with a bicuspid aortic valve usually comes to attention due to the presence of a heart murmur or an abnormal heart sound. There are many other different causes of heart murmurs, including normal causes. [pediatricheartspecialists.com]

• Systolic Murmur

  An attenuation of systolic murmur also occurred. No aortic diastolic murmur was detected. [jpgmonline.com]

  3/6 or louder systolic murmur. [aafp.org]

  On clinical examination the patient had severe aortic stenosis with a slow rising pulse, narrow pulse pressure, and an ejection systolic murmur radiating to the carotids. … View Full Text Log in Log in using your username and password Log in through your [bmj.com]

  On clinical examination the patient had severe aortic stenosis with a slow rising pulse, narrow pulse pressure, and an ejection systolic murmur radiating to the carotids. He had left ventricular failure. [ncbi.nlm.nih.gov]

  Physical examination is notable for a 3/6 crescendo-decrescendo systolic murmur present at the right upper sternal border with radiation to the carotid arteries. Random blood glucose is 205 mg/dL. [medbullets.com]

• Diastolic Murmur

  No aortic diastolic murmur was detected. [jpgmonline.com]

  Clinically he had severe aortic regurgitation with a collapsing pulse, positive Corrigan's sign, a loud early diastolic murmur, and additional diastolic deep rumble (Austin Flint murmur). He had evidence of cardiac failure. [ncbi.nlm.nih.gov]

  Such pathology may cause leakage from the valve too and with it an early diastolic murmur. The typical murmur of AS is a crescendo-decrescendo systolic ejection murmur shortly after the first heart sound that ends just before the second heart sound. [patient.info]

  A systolic murmur is usually aortic stenosis, while a diastolic murmur indicates aortic insufficiency. A cardiologist confirms the guess with an echocardiogram to determine the severity. [heartlifeinsurance.com]

  murmur Cyanosis or clubbing Persistent rales Peripheral edema CARDIOVASCULAR DIAGNOSTIC TESTING DURING PREGNANCY Electrocardiographic evaluation The resting electrocardiogram may change with pregnancy ( Table 6 ). [glowm.com]

• Pulsus Parvus et Tardus

  parvus et tardus weak pulses with a delayed peak Imaging Radiography indication for all patients findings cardiomegaly calcification pulmonary congestion Echocardiography indications for all patients diagnostic test views transthoracic echocardiogram [medbullets.com]

  Signs Examination of the pulse in significant AS reveals a slow-rising, flat character called pulsus parvus et tardus. [ 7 ] Blood pressure will show a narrow pulse pressure (difference between systolic and diastolic pressures). [patient.info]

  The phenomenon known as pulsus parvus et tardus refers to a weak (parvus) and delayed (tardus) carotid upstroke. To asses for parvus, it is often helpful to palpate one’s own carotid artery while concurrently palpating the patient’s carotid artery. [healio.com]

• Fracture

  Intraoperative and pathologic examination showed bicuspid aortic valve with symmetric cusps, straight and fibrotic cusp edges and fractured calcific nodules of the aortic valve. [ncbi.nlm.nih.gov]

  Inflating the balloon is meant to fracture some of the calcium deposits on the valve, thus allowing the valve to open more completely, and relieving part of the obstruction. [verywell.com]

• Dizziness

  Symptoms of a stenotic valve include chest pain, shortness of breath and dizziness or fainting caused by inadequate blood flow to the brain. If the bicuspid valve does not close completely, blood can flow backwards into the heart. [my.clevelandclinic.org]

  Should a child develop moderate or severe tightness (aortic stenosis) or leaking (aortic regurgitation), or severe dilation of the ascending aorta, he or she might show signs of shortness of breath, exercise intolerance, fatigue, chest pain, dizziness [childheartassociates.com]

  […] with a bicuspid valve are asymptomatic, the most common symptoms include: Shortness of breath, during exercise or when you are lying in bed Constant tiredness or fatigue Coughing at night or when in bed Rapid or fluttering heart palpitations Feeling dizzy [uofmhealthblogs.org]

  Although some people with a bicuspid valve are asymptomatic, common symptoms include: Shortness of breath Constant tiredness or fatigue Coughing at night or when in bed Rapid or fluttering heart palpitations Dizziness Chest pain (tightness, angina) Fainting [healthblog.uofmhealth.org]

  […] become more severe and cause: chest pain brought on by physical activity (angina) – caused by your heart having to work harder shortness of breath – at first you may only notice this when you exercise, but later you may experience this even when resting dizziness [nhs.uk]

The size of the proximal aorta should be evaluated carefully during the workup. [en.wikipedia.org]

Diagnosis of aortic stenosis is suspected on physical examination (abnormal heart sounds, abnormalities in the pulse) and confirmed by echocardiography. 2,9 (For a detailed description of the history, physical examination, differential diagnosis, and workup [uspharmacist.com]

• Calcified Aortic Valve

  Unfortunately, in older people with heavily calcified aortic valves, the results with valvulotomy have not been good. [verywell.com]

  Significant calcification is associated with relatively rapid progression. 4 The clinical criteria involved in diagnosing calcified aortic valve stenosis include the medical history and physical examination findings. [scielo.br]

  On transthoracic echocardiogram, the parasternal short-axis view showed a calcified aortic valve with probable bicuspid morphology (panel A). [tandfonline.com]

  aortic valves, although it can occur in the geriatric patient population. 6 Hospital-acquired Staphylococcus aureus bacteremia can occur at any age and is often seen as a consequence of aortic valve replacement. 6 Prognosis Sudden death, while occurring [uspharmacist.com]

  Rare initial symptoms in a patient with aortic stenosis include embolic phenomenon from calcified aortic valve plaques or massive GI bleeding due to angiodysplasia (Heyde’s syndrome). [healio.com]

• Left Ventricular Hypertrophy

  Left ventricular hypertrophy is present in bicuspid aortic stenosis. [5] Pathological Findings Images shown below are courtesy of Professor Peter Anderson DVM PhD [6] and published with permission. [wikidoc.org]

  If there are signs of left ventricular hypertrophy (thickening of the ventricle walls) or arrhythmia in conjunction with moderate stenosis, then the patient should be confined to moderate levels of isotonic exercise and should avoid isometric exercise [pted.org]

  The electrocardiograms showed a progressive left ventricular hypertrophy with strain which developed over the last 10 years. [jpgmonline.com]

  A S4 heart sound is also often present due to the severe concentric left ventricular hypertrophy that develops in aortic stenosis. [healio.com]

  Not helpful in screening of BAV Image : “Left ventricular hypertrophy in short axis view.” by Patrick J. Lynch, medical illustrator. [lecturio.com]

الصفحة 24 - Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). ‏ الصفحة 134 - Sacks FM, Pfeffer MA, Moye LA et al. [books.google.com]

WASHINGTON — Treatment of bicuspid aortic stenosis with transcatheter aortic valve replacement was comparable to transcatheter aortic valve replacement in tricuspid aortic stenosis, but the procedure was more successful with newer-generation systems, [healio.com]

Although surgical correction is a more definitive treatment modality, BAV has a long-term durability and is the treatment of choice in patients presenting early. [louisville.edu]

[…] stenosis, valve repair or replacement remains the only definitive treatment. [heart.ucla.edu]

Children with mild aortic stenosis rarely require treatment. However, it is important to note that aortic stenosis may be progressive, and that children with mild disease may eventually require treatment later in life. [cincinnatichildrens.org]

Natural History and Prognosis Valvular AS is frequently a progressive disease, the severity increasing over time. [rjmatthewsmd.com]

There is a favorable long-term outcome following aortic valve surgery and relatively low operative risk. 6 This should be considered in light of the prognosis of congestive heart failure in the very old as worse than the prognosis of most cancers ( 1 [uspharmacist.com]

MSCT may be useful in quantifying the valve area and coronary calcification, which aids in assessing prognosis. [patient.info]

Treatment and prognosis A minority of patients develop aortic regurgitation as a young adult but the majority have progressive valve stenosis, with only about 1% maintaining normal valve function over their lifetime 10. [radiopaedia.org]

Over the past 60 years, the etiology of most valvular heart diseases in industrialized countries shifted towards degenerative etiologies, mainly because of a decrease in acute rheumatic fever. [textbookofcardiology.org]

The University of Michigan is home to the International Registry of Aortic Dissection, and several research laboratories that are exploring the molecular etiologies of aortic diseases. [umcvc.org]

[…] definition narrowing of the aortic valve Epidemiology demographics bicuspid aortic valve calcification presents at a younger age tricuspid aortic valve calcification 65 years of age risk factors hypertension coronary artery disease rheumatic heart disease Etiology [medbullets.com]

Etiology – Aortic Stenosis The most common cause of aortic stenosis in a person over age 70 years is calcification of a normal trileaflet aortic valve; this process is sometimes referred to as “senile degeneration.” [healio.com]

The TVT registry does not allow for further details of stroke, but it is reasonable to assume an embolic etiology from the calcified valve itself. [acc.org]

Introduction Clinical definition narrowing of the aortic valve Epidemiology demographics bicuspid aortic valve calcification presents at a younger age tricuspid aortic valve calcification 65 years of age risk factors hypertension coronary artery disease [medbullets.com]

Epidemiology Valvular heart diseases are a major burden to society and it is expected that the prevalence will increase. Rheumatic valve disease used to be the most prevalent etiology of valvular cardiac diseases worldwide. [textbookofcardiology.org]

Epidemiology of Bicuspid Aortic Valve Disease Bicuspid aortic valve disease is one of the prominent causes of death worldwide and considered one of the most common causes of inherited heart diseases. [lecturio.com]

Epidemiology [ 1 ] AS has become the most frequent type of valvular heart disease in Europe and North America. [patient.info]

Complications stemming from structural heart issues are most often treated through surgical intervention, which could include aortic valve replacement, or balloon valvuloplasty. [16] Epidemiology [ edit ] Bicuspid aortic valves are the most common cardiac [en.wikipedia.org]

[…] of the aorta. [1] Pathophysiology of Aortic Stenosis The pathophysiology of aortic stenosis is described in the main chapter on the pathophysiology of aortic stenosis here. [wikidoc.org]

1243 Percutaneous Coronary Intervention 1258 Percutaneous Cardiac Procedures 1273 Coronary Artery Bypass Surgery 1290 Approaches to the Patient with Prior Bypass Surgery 1306 Percutaneous Valve Dilatations 1316 Global Pandemic of Heart Failure 1330 Pathophysiology [books.google.com]

Cardiol Res Pract. 2012;2012:478259. doi: 10.1155/2012/478259. 26 - Pathophysiological implications of different bicuspid aortic valve configurations. Kari FA, Beyersdorf F, Siepe M. [escardio.org]

Pharmacotherapy: A Pathophysiologic Approach. 7th ed. New York, NY: McGraw-Hill Inc.; 2008:315-330. 15. Novaro GM, Tiong IY, Pearce GL, et al. [uspharmacist.com]

The Pathology,Pathophysiology,Recognition,and Treatment of Congenital Heart Disease,Hurst's Diseases of The Heart,10th edition,Vol.2,Pp.1837-1905. [rjmatthewsmd.com]

Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. ‏ [books.google.com]

Both are safe and effective ways of managing bicuspid aortic stenosis and both prevent the adverse effects described above. [louisville.edu]

Bicuspid Aortic Valve - How to prevent? Bicuspid Aortic Valve - Preparing for surgery Bicuspid Aortic Valve - Post-surgery care Bicuspid Aortic Valve - Other Information [singhealth.com.sg]

Medicine may be needed to relieve symptoms or prevent complications. [medlineplus.gov]

Make sure it's well-controlled to prevent aortic regurgitation. Aug. 02, 2017 [mayoclinic.org]