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At least 253 records · Page 14Linked to original sources
PubMedDate not supplied

Infective endocarditis of bicuspid pulmonary valve.

Infective endocarditis of the cardiac valves mainly involves the aortic mitral valves and less frequently the tricuspid valve. Isolated pulmonary valve involvement is extremely rare with few cases reported in literature. We present a case of a 34-year-old female who presented with sudden onset breathlessness and cardiac failure. A complete autopsy showed an uncommon congenital bicuspid pulmonary valve, which was also affected by infective endocarditis.

Adult↗
PubMed2005

Infundibular ventricular septal defect, aneurysm of the sinus of Valsalva, and bicuspid aortic valve in a caucasian male.

We report the case of a Caucasian man with the unusual combination of an infundibular ventricular septal defect (VSD), an aneurysm of the sinus of Valsalva communicating with the right ventricle, and a bicuspid aortic valve. When aortic valve regurgitation associated with mild right aortic cusp prolapse appeared during follow-up examination, the patient, although totally asymptomatic, underwent surgical repair of the aortic sinus and closure of the VSD.

Adult↗
PubMed2006

Hematoma of a congenitally bicuspid aortic valve in a patient with polycythemia vera and the antiphospholipid antibody syndrome.

We present a novel case of a hematoma involving a congenitally bicuspid aortic valve. The patient was a 47-year-old woman with polycythemia vera and antiphospholipid antibody syndrome. She was treated with anagrelide for thrombocytosis. The patient developed a valvular hematoma which caused clinically significant aortic stenosis and regurgitation. Consequently, the patient underwent surgery with insertion of a porcine bioprosthesis. Eighteen months postoperatively the patient developed a large prosthetic thrombus with severe aortic stenosis requiring reoperation.

Antiphospholipid Syndrome↗
PubMed2005

Acute traumatic disruption of a bicuspid aortic valve.

Cardiac involvement is frequent in patients with blunt chest trauma and multiple injuries. Different cardiac structures can be involved, but isolated aortic valve rupture is rare. We report the case of a man admitted to our hospital with multiple injuries as a result of a car crash. Transthoracic, followed by transesophageal echocardiography, revealed disruption of a large anterior bi-coronary cusp in a bicuspid valve with severe aortic regurgitation, without lesions or abnormalities of thoracic aorta. Aggressive pharmacological management consented to delay valve replacement to obtain resolution of concomitant pulmonary injuries.

Accidents, Traffic↗
PubMedDate not supplied

Fatal ascending aorta-to-right ventricle fistula formation after Staphylococcus aureus endocarditis of bicuspid aortic valve.

We present a case of a 46-year-old man with advanced acquired immunodeficiency syndrome and congenitally bicuspid aortic valve endocarditis caused by methicillin- and gentamicin-resistant Staphylococcus aureus. Endocarditis led to root abscess formation, a complete heart block, and fistulous tract formation between the ascending aorta and the right ventricle. Although perivalvular abscess is not an unusual complication of native valve endocarditis, a fatal fistulous communication between the ascending aorta and the right ventricle is exceedingly rare.

Aorta, Thoracic↗
PubMed2004

Combination of traumatic pseudoaneurysm of descending thoracic aorta and bicuspid aortic valve endocarditis in a young adult.

We report on a 26-year-old man who injured in an automobile accident and developed post-traumatic bicuspid aortic valve endocarditis associated with severe regurgitation. In addition, transesophageal echocardiography (TEE) revealed a pseudoaneurysm of the descending thoracic aorta. The combination of medical and surgical therapy led to a favorable outcome.

Accidents, Traffic↗
PubMed2004

Morphology of bicuspid aortic valve in children and adolescents.

OBJECTIVES: The aim of this study was to determine the relationship between aortic valve morphology and valve dysfunction. BACKGROUND: The morphology of the bicuspid or bicommissural aortic valve (BAV) may predict the severity of valve dysfunction. Therefore, we assessed the relationship between BAV, aortic coarctation, and the degree of valve pathology in children. METHODS: A retrospective review of 1,135 patients with BAV who were identified between 1986 and 1999 was performed. Patients younger than 18 years of age with BAV that was identifiable via echocardiography were included. The most recent or last study of each patient before intervention or endocarditis was reviewed. Mild stenosis was defined as a valve gradient > or =2 m/s, moderate or greater aortic stenosis as > or =3.5 m/s. Aortic regurgitation was quantified using standard criteria. RESULTS: Median age was 3 years (range, 1 day to 17.9 years), and 67% of the patients were male. Right-coronary and left-coronary leaflet fusion were the most common types of BAV (70%). Aortic stenosis that was moderate or greater was observed most often in patients with right-coronary and non-coronary leaflet fusion (odds ratio 2.4, 95% confidence interval 1.6 to 3.6; p < or = 0.001). Similarly, right-coronary and non-coronary leaflet fusion was more often associated with moderate aortic regurgitation or greater (odds ratio 2.4, 95% confidence interval 1.2 to 4.7; p = 0.01). The majority of patients with aortic coarctation had fusion of the right-coronary and left-coronary leaflets (89%), and aortic coarctation was associated with lesser degrees of valve stenosis or regurgitation. CONCLUSIONS: Analysis of BAV morphology is of clinical and prognostic relevance. Fusion of the right-coronary and non-coronary leaflets was associated with more significant valve pathology, whereas fusion of the right-coronary and left-coronary leaflets was associated overwhelmingly with aortic coarctation and less aortic valve pathology.

Adolescent↗
PubMed2005

Matrix metalloproteinases in ascending aortic aneurysms: bicuspid versus trileaflet aortic valves.

BACKGROUND: Abnormal matrix metalloproteinase (MMP) and tissue inhibitor of metalloproteinase (TIMP) expression contributes to the development of abdominal aortic aneurysms. Recent data suggest that MMP-2 and MMP-9 may also play a role in thoracic aortic disease. We sought to determine (1) whether ascending aortic aneurysms are associated with increased MMP expression and (2) whether aortic inflammation and MMP expression differ between patients with congenital bicuspid aortic valves (BAVs) and those with trileaflet aortic valves (TAVs). MATERIALS AND METHODS: Samples of ascending aortic aneurysms were obtained from 29 patients; 14 patients had BAVs and 15 had TAVs. Control ascending aorta was obtained from 14 organ donors or heart transplant recipients. Aortic histology and immunohistochemistry were performed to evaluate elastin degradation, inflammatory changes, and MMP-2 and MMP-9 expression. Aortic levels of MMP-2, MMP-9, TIMP-1, and TIMP-2 were measured using ELISA. RESULTS: Aneurysms in the TAV patients exhibited marked inflammation, high CD68 expression, diminished elastin content, increased MMP-9 expression, and normal MMP-2 levels. In contrast, BAV aneurysms were characterized by a relative lack of inflammation, preservation of elastin content, normal MMP-9 levels, and elevated MMP-2 expression. TIMP-1 and TIMP-2 levels were not significantly different among the three groups. CONCLUSIONS: Ascending aortic aneurysms exhibited increased MMP expression. The pattern of MMP expression and the degree of inflammation, however, differed between aneurysms associated with BAVs and those with TAVs. Variations in the molecular mechanisms underlying different types of thoracic aortic aneurysms warrant further investigation.

Adult↗
PubMed2003

Changes in size of ascending aorta and aortic valve function with time in patients with congenitally bicuspid aortic valves.

Bicuspid aortic valve (BAV) is associated with premature valve dysfunction and abnormalities of the ascending aorta. Limited data exist regarding serial changes of aortic dilation in patients with BAV. We studied paired transthoracic echocardiograms of 68 patients with BAV (mean age 44 years) and with at least 2 examinations >12 months apart (mean follow-up 47 months) to characterize the progression of aortic dilation and the natural history of valve function. We measured aortic root and ascending aortic diameters at baseline and follow-up. We measured aortic gradients and severity of aortic regurgitation (AR). During follow-up, aortic diameters increased at the sinuses of Valsalva by 1.9 mm (95% confidence interval [CI] 1.3 to 2.5), at the sinotubular junction by 1.6 mm (95% CI 0.8 to 2.3), and at the proximal ascending aorta by 2.7 mm (95% CI 1.9 to 3.6). Mean rate of diameter progression was 0.5 mm/year at the sinuses of Valsalva (95% CI 0.3 to 0.7), 0.5 mm/year at the sinotubular junction (95% CI 0.3 to 0.7), and 0.9 mm/year at the proximal ascending aorta (95% CI 0.6 to 1.2). Progression was observed regardless of hemodynamic function at baseline. Mean aortic valve gradient increased significantly from baseline to follow-up (17.6 mm Hg vs 25.7 mm Hg, p <0.001). The degree of AR increased during follow-up in 17 patients (25%). In addition, progression of aortic diameter dilation occurred irrespective of baseline valve function in adult patients with BAV. We also observed considerable progression of aortic gradients and AR over time.

Adult↗
PubMed2002

Early results of valved bovine jugular vein conduit versus bicuspid homograft for right ventricular outflow tract reconstruction.

BACKGROUND: Homograft conduits are preferable for right ventricular outflow tract reconstruction in children, but their limited availability remains a major concern. Recently, a valve-containing segment of bovine jugular vein (Contegra, Medtronic Inc, Minneapolis, MN) has been introduced as a potential alternative conduit. METHODS: Early clinical and echocardiographic results of right ventricular outflow tract reconstruction were retrospectively compared between 41 children (mean age, 1.9 years), receiving a Contegra conduit and 36 patients (mean age, 2.7 years) with a size-reduced pulmonary homograft. RESULTS: Clinical outcome was comparable with two early deaths in the homograft group and one in the Contegra group. There were no conduit-related complications in either population. Early echocardiographic assessment showed only trivial to mild regurgitation in 9 homografts versus 17 Contegra conduits. The peak gradient across the right ventricular outflow tract conduit was comparable for both groups, although a larger number of patients, treated with a downsized homograft, had a small gradient at the distal junction with the pulmonary arteries (12 versus 6 patients). None of the patients had a gradient at the valvar level. CONCLUSIONS: The valved bovine jugular vein conduit offers a promising substitute for right ventricular outflow tract reconstruction in infants and children, with an early hemodynamic performance that compares favorably with downsized, bicuspid homografts. Clinical advantages are greater shelf availability and the natural continuity between valve and conduit, which allows proximal infundibular shaping without additional material. However, durability must be determined, even though most of these children will require right ventricular outflow tract reoperation after outgrowing the conduit.

Adolescent↗
PubMed2002

Aortic complications after bicuspid aortic valve replacement: long-term results.

BACKGROUND: Bicuspid aortic valve (BAV) is a risk factor for aortic dissection and aneurysm. We studied patients with BAV and tricuspid aortic valve (TAV) to evaluate long-term changes in the ascending aorta after aortic valve replacement (AVR). PATIENTS AND METHODS: One hundred consecutive patients were allocated into two groups according to the presence of BAV (group A, 50 patients) or TAV (group B, 50 patients). Mean age was 51 +/- 12 years in group A, and 50 +/- years 12 in group B. No patients had hypertension or Marfan's syndrome. Until July 2001, mean follow-up was 234 +/- 47 months in group A and 241 +/- 43 months in group B. RESULTS: Five patients (10%, CL 5.7 to 13.9) in group A suffered late acute aortic dissection. Acute aortic dissection (5 vs 0, p = 0.0001) and sudden death (7 vs 0, p = 0.0001) occurred more frequently in patients with BAV. All survivors were assessed by echocardiogram. The mean diameter of the ascending aorta was 48.4 mm in group A and 36.8 mm in group B. Three patients in group A were operated on because of ascending aorta aneurysm more than 6 cm in diameter. CONCLUSIONS: As a result of our experience, we recommend a policy of prophylactic replacement of even a seemingly normal and definitely a mildly enlarged ascending aorta in cases of BAV at the moment of AVR, and consideration of a similar approach for any other cardiac surgical procedure in patients with BAV.

Acute Disease↗
PubMed2004

The congenitally bicuspid aortic valve: how does it function? Why does it fail?

BACKGROUND: The study was intended to investigate the reason why congenitally bicuspid valves (CBAVs), which may function hemodynamically and clinically well, have a high early failure rate. METHODS: Observations were made on cryopreserved, then thawed human aortic roots containing CBAVs. Valvular function was studied in the left heart simulator using conventional and 500-frames/second cinematography, intravascular ultrasound, by preparation of silicone molds, and by computerized digital modeling. RESULTS: The function of the clinically "normal" CBAVs is characterized by (a). excessive folding and creasing, which (unlike in the trileaflet valve) persist throughout the cardiac cycle; (b). extended areas of leaflet contact; (c). significant morphologic stenosis; and (d). asymmetrical flow patterns and turbulence. CONCLUSIONS: The above features subject the CBAV to abnormally high stresses and may lead to early thickening and eventually calcification and stenosis. The abnormal flow patterns also predilect for dilatation and dissection of the ascending aorta.

Aortic Valve↗
PubMed2004

Successful repair of aberrant right subclavian artery aneurysm combined with bicuspid aortic valve through a median sternotomy.

We report a case of a successfully repaired aberrant right subclavian artery aneurysm combined with bicuspid aortic valve using a multibranched vascular prosthesis. Approaching solely through a median sternotomy under cardiopulmonary bypass, hypothermic circulatory arrest, and selective cerebral perfusion, we performed a successful single-stage correction by aortic valve replacement, resection of aneurysm, and reconstruction of the right subclavian artery.

Aged↗
PubMed1997

Commissurotomy and bileaflet pericardial augmentation-resuspension for bicuspid aortic valve stenosis.

We describe a valve reconstruction technique for congenital bicuspid aortic valve stenosis employing a commissurotomy, resection of raphe between conjoint leaflets, and bileaflet augmentation-resuspension using a triangular strip of glutaraldehyde-preserved autologous pericardium. This maneuver relieves aortic valve stenosis, preserves the native valve leaflets, reproduces the natural trileaflet scalloping of the aortic valve annulus, and improves cusp coaptation.

Aortic Valve Stenosis↗
PubMed1997

Repair of congenital pulmonary incompetence by bicuspidization of the pulmonary valve.

We report the successful repair of pulmonary incompetence in an adult due to the congenital absence of the posterior leaflet of the pulmonary valve. The repair consisted of bicuspidization of the pulmonary valve, which achieved competence and eliminated the symptoms and echocardiographic manifestations of right ventricular overload while preserving the native valve.

Female↗