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]

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. [jhu.pure.elsevier.com]

Failure to present until clinical symptoms develop—either because the murmur is not detected or is lost to follow-up—can have important consequences. [bmj.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]

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

  Therefore, if the patient needs surgery, the size of the aorta will determine what type of surgery should be offered to the patient. [3] Associated Congenital Heart Disease Patients with bicuspid aortic valve are also at higher risk of aortic coarctation [wikidoc.org]

• Heart Disease

  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]

  Disease 502 The Heart and Pregnancy 537 Chapter32 Women and Heart Disease 553 The Elderly and Aging 561 Chapter34 EndofLife Care 587 The Heart and Other Organ Systems 595 Chapter 35B Hematologic Disorders and the Heart 604 Chapter35C The Heart and the [books.google.com]

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

  The bicuspid aortic valve and associated aortic disease. In: Otto CM, Bonow RO, eds. Valvular Heart Disease: A Companion to Braunwald's Heart Disease. 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 13. Carabello BA. Valvular heart disease. [medlineplus.gov]

  The Cardiology section is involved in treating patients with disorders of the heart and vascular tree including coronary artery disease, congestive heart failure, valve disease, congenital heart defects, cardiomyopathy and peripheral vascular disease. [hopkinsmedicine.org]

• 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 exam reveals a systolic crescendo-decrescendo murmur, heard best at the heart base and radiates to the carotids. He is sent for further evaluation with an echocardiogram. [medbullets.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]

  A pulsus parvus et tardus (the arterial pulse is slow to increase and has a reduced peak) can be appreciated by palpating the carotid pulse of patients with severe aortic stenosis. [textbookofcardiology.org]

• Narrow Pulse Pressure

  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]

  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]

• 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]

  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]

  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]

  […] 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

  In young patients with congenital forms of aortic stenosis, valvulotomy is often a good option. Unfortunately, in older people with heavily calcified aortic valves, the results with valvulotomy have not been good. [verywell.com]

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

  […] valvular stenosis (see Reference 20). 6,20,21 In younger patients with mild valvular deformity, the risk of infective endocarditis is higher as compared with older patients with degenerative calcified aortic valves, although it can occur in the geriatric [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]

  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]

  4 Left ventricular hypertrophy secondary to aortic stenosis, as well as age-related changes, both promote diastolic dysfunction, rendering the geriatric patient with aortic stenosis more dependent on contraction of the atrium for filling the ventricle [uspharmacist.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]

Conversely, even if no symptoms are present, it may be advisable to proceed with treatment or repairs based on the test results. Possible treatments may include valve repair or valve replacement. [heart.org]

Treatments There are essentially three treatment options for aortic stenosis: surgical valve replacement, transcatheter aortic valve replacement (TAVR), or medical therapy. [secondscount.org]

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

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]

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]

Etiology can be organic or functional. [textbookofcardiology.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 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]

However, epidemiological studies, histopathological studies and recent experimental evidence have indicated that calcification of the aortic valve is an active biological process rather than a passive process within the leaflet, thus causing regulated [scielo.br]

[…] 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]

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]

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]

Freed,M.D.,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]