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PubMed2000

[Clinicopathologic study of congenital bicuspid aortic valve in the aged].

Congenital bicuspid aortic valve was found in 25 patients(18 men, 7 women, mean age 78 years) of 7,000 consecutive autopsy cases over 60 years old(0.36%). Nine cases showed aortic stenosis(Group AS), 7 cases showed aortic stenosis and regurgitation(Group ASR) (4 cases with stenosis dominancy, 3 cases with regurgitation dominancy), 9 cases showed no aortic stenosis or regurgitation(Group Non-ASR) and no cases showed pure aortic regurgitation. The groups were compared clinically and pathologically. Cardiac death was frequently found in Groups AS and ASR. The aortic valve was the thickest in Group AS(6.0 +/- 2.1 mm), and thicker in Group ASR (4.6 +/- 1.8 mm) than in Group Non-ASR(2.3 +/- 1.1 mm). Seventeen cases(68%) had right-left cusps of the aortic bicuspid valve and 8 cases(32%) had anterior-posterior cusps. Raphe was seen in 18 cases(72%) and was more frequent in Groups ASR and Non-ASR than in Group AS. Especially, all cases had raphes in Group Non-ASR. Calcification was severe in Group AS and in cases with stenosis dominancy in Group ASR. However, calcification was limited in cases with regurgitation dominancy in Group ASR. Calcification was limited or not present in Group Non-ASR. In this study, the frequency of the bicuspid aortic valve in the aged, the ratio of stenosis to regurgitation, and the distribution of calcification in the valve were established. The bicuspid aortic valve did not necessarily become stenotic, and there were cases having no stenosis or regurgitation. Especially, it was shown that cases without raphe were prone to have marked calcification and to become stenotic. On the other hand, cases with raphe were not prone to become stenotic.

Aged↗
PubMed1975

[Radiological study of congenital mono and bicuspid aortic valves (author's transl)].

Bicuspid aortic valves are much more common than monocuspid valves and diagnosed by A. P. aortography and, above all, lateral views. One may distinguish the true bicuspid valves which include two Valsalva sinuses, often asymmetrical, and bicuspid valves whith a supplementary raphe, the commonest type, in which on angiography, one may distinguish three Valsalva sinuses, one of which is larger than the two others. These cases of bicuspid aortic valve may be associated with other malformations of the aorta or may occur alone. In the latter case, the main risks are aortic valvular stenosis or aortic incompetence.

Aortic Coarctation↗
PubMed2002

Bicuspid aortic valve.

The bicuspid aortic valve is a common congenital cardiac anomaly, having an incidence in the general population of 0.9% to 2.0% and a frequency of 54% in all patients aged >15 years with valvular aortic stenosis. In most cases it remains undetected until infective endocarditis or calcification supervenes. The bicuspid aortic valve may function normally throughout life, may develop progressive calcification and stenosis or may develop regurgitation with or without infection. The association of the bicuspid aortic valve with dissection of the aorta is also common. The recognition of the bicuspid valve in patients with aortic valve disease remains an important challenge to the clinician, whereas preoperative knowledge of valve morphology would be helpful in planning the surgery. Antibiotic prophylaxis is also recommended in such patients, since these valves are likely to become the most important intrinsic cardiac predisposition for infective endocarditis with the virtual disappearance of rheumatic fever in developed countries.

Aortic Valve↗
PubMed1992

[Echocardiographic assessment of aortic regurgitation and aortic root dilatation in bicuspid aortic valve].

Aortic regurgitation (AR) and aortic root dilatation in 29 consecutive patients with bicuspid aortic valves but without aortic root disease (20 males, and 9 females: aged 27-85 years) were studied using two-dimensional echocardiography. The normal ranges of aortic root dimensions were calculated from values of 185 normal subjects, as 95% confidence intervals. AR was observed in 17 patients by color flow mapping. In 12 of the 17 AR patients, no significant lesion of the aortic cusp was detected by two-dimensional echocardiography. These 12 AR patients were compared with 12 patients without AR. Increase in dimension of the aortic root was relatively frequent in the 12 AR patients at the aortic annulus (AA) (67 vs 17%, p < 0.05), and at the sinus of Valsalva (A1) (67 vs 17%, p < 0.05). At the ascending aorta 5 mm distal to the sinus of Valsalva (A2), the difference was not significant (58 vs 17%, p < 0.09). The 12 bicuspid AR patients without significant lesions of the aortic cusp were compared with 41 AR patients with normal tricuspid aortic valves. The frequencies of cases with increased aortic root dimension were 67 vs 46% (ns) at the AA, 67 vs 22% (p < 0.05) at A1 and 58 vs 5% at A2 (p < 0.01). Thus, aortic annular dilatation was thought to be the cause of AR in bicuspid and tricuspid aortic valves without significant lesions of the aortic cusps, and generalized dilatation of the aortic root was more frequent in bicuspid AR patients than in tricuspid AR patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Congenital bicuspid aortic valve: stenotic type and insufficient type].

Two-hundred and eighty-one patients underwent surgical treatment of the aortic valves during a 10-year period of 1981 to 1991, 32 of whom (11%) had bicuspid aortic valve. Bicuspid aortic valve is well known to cause calcified aortic stenosis, however, some of these cases develop pure aortic insufficiency of unknown etiology. In our studies of 32 patients with bicuspid aortic valve, 28 patients had aortic stenosis, 2 were aortic insufficiency and 2 were infective endocarditis. Pathogenesis of aortic insufficiency in patients with bicuspid aortic valves was discussed and compared with that of aortic stenosis.

Adult↗
PubMed1991

The neural crest as a possible pathogenetic factor in coarctation of the aorta and bicuspid aortic valve.

Patients (n = 109) operated on for coarctation of the aorta were analyzed for occurrence of associated cardiac and noncardiac anomalies. Attention was also paid to the prevalence of cardiac anomalies in the relatives of these patients. Of the patients with coarctation of the aorta, 57 (52%) had a bicuspid aortic valve. Forty-three (39%) of the 109 patients had one or more noncardiac anomalies. In 29 (27%) patients the noncardiac anomaly involved the head/neck structures. Noncardiac anomalies were much more prevalent in patients with coarctation and bicuspid aortic valve, especially anomalies involving the head/neck structures: 44% compared to 8% of patients with a normal aortic valve. Congenital cardiac malformations were present in relatives in the first or second degree of 18% of the patients. Bicuspid aortic valve was more prevalent in patients with an affected relative (75%) than in patients with unaffected relatives (47%). Recent studies showed that the neural crest plays an important role in the development of cardiac and a variety of noncardiac structures. The cardiac structures derived from the neural crest involve the outflow tract of the heart and the aortic arch system. Maldevelopment of neural crest cells could therefore be responsible for the combined occurrence of outflow tract (e.g., bicuspid aortic valve), aortic arch (e.g., coarctation), and noncardiac anomalies. This study supports the concept that some anomalies of the aortic arch system, including aortic coarctation, are cardiovascular manifestations of a spectrum of anomalies involving the head and neck region that may be due to a genetic-environmental disorder of the neural crest.

Aortic Coarctation↗
PubMed1991

[Congenital bicuspid aortic valve associated with aberrant coronary artery origin: a case report].

A 61-year-old man with congenital bicuspid aortic valve associated with aberrant coronary artery origin is presented. His aortic valve was severely stenotic with marked calcification. At the aortic valve replacement, it was found that the valve was markedly calcified and the bicuspid valve and both coronary ostia were very close to each other in a posteriorly positioned sinus of Valsalva. There have been a few reports concerning the combination of the bicuspid aortic valve and aberrant coronary artery origin, and it is well known that the bicuspid aortic valve more frequently accompanies short left main trunk or left coronary arterial dominance than a normal aortic valve. Some genetic mechanisms surrounding the coronary artery, aortic valve and aorta are suggested to occur with such anomalies.

Aortic Valve↗
PubMed1990

[Pure aortic regurgitation due to congenital bicuspid valve: a case report].

A rare case of pure severe aortic regurgitation (AR) accompanied with congenital bicuspid aortic valve is presented. A 36-year-old female was admitted with rapid development of congestive heart failure. Examinations clarified severe AR with congenital bicuspid valve. Either calcification or vegetation on the valve was completely denied. At operation, both leaflets were apart from each other with a distance of 7 mm at the anterior commissura. A mechanical valve (Björk-Shiley 23A) was sutured and she has been well. Pathological study of the resected leaflets revealed neither calcium deposit nor finding of infection but collagenous fibrous tissue with focal mucinous degeneration. A few cases of AR with bicuspid aortic valve have been reported in patients of annuloaortic ectasia. The partial annular ectasia was suspected as the cause of solitary aortic regurgitation with bicuspid aortic valve in our case.

Adult↗
PubMed1986

[Significance of the bicuspid aortic valve in the incidence of aortic valve defects in adults].

In 388 patients with severe isolated aortic valve disease bicuspid aortic valves were found in 45% of patients with aortic stenosis and 24% of patients with aortic regurgitation. There was a history of rheumatic fever in 16% and of endocarditis in 7% of these patients. In a group of 110 patients with severe combined aortic and mitral valve disease, 50% had a history of rheumatic fever and bicuspid valves were found in only 12% of the cases. Severe aortic valve disease based on bicuspid valves was most frequently found in the age group 50-69 years. Bicuspid aortic valve is today the most frequent cause of isolated aortic valve disease; it is more common in aortic stenosis but also occurs in aortic regurgitation.

Adolescent↗
PubMed1993

Artificial valve replacement for congenital bicuspid aortic valves.

The congenital bicuspid aortic valve functions almost normally provided degeneration does not occur, but complications of infective endocarditis and calcification of the cusps with aging are indications for surgical intervention. We compared 22 cases with an incompetent bicuspid aortic valve (14 cases with stenosis and eight with regurgitation) with 96 cases of acquired tricuspid aortic valve (30 cases with stenosis and 66 with regurgitation) who were treated by aortic valve replacement (AVR) during the same period. Compared with the stenotic tricuspid aortic valve cases, the stenotic bicuspid aortic valve cases: 1) were older at AVR (59.3: 51.7 years, P < 0.05), 2) had a smaller diameter of preoperative valve orifice (6.9: 9.2 mm, P < 0.05), 3) had a smaller valve ring diameter (23.0: 24.3 mm, P < 0.05), 4) used artificial valves of almost identical size (22.0: 22.5), and 5) included no operative deaths (0: 10%). In contrast, compared with the tricuspid aortic valve cases with regurgitation, the bicuspid aortic valve cases with regurgitation: 1) were younger at AVR (39.5: 45.8 years), 2) had a higher incidence of infective endocarditis (62.5: 19.6%, P < 0.02) as a complication, and 3) showed a higher operative death rate (25.0: 6.1%), although this difference was not statistically significant. Suture repair of the incised portion of the aorta must be performed meticulously in patients with prominent poststenotic dilatation of the ascending aorta.

Adolescent↗
PubMed1996

[A case of ruptured sinus of Valsalva aneurysm with bicuspid aortic valve].

A 40-year-old male underwent operation with a suspected diagnosis of a ruptured of Valsalva aneurysm and a bicuspid aortic valve. The aneurysm with an apical rupture protruded into the membranous septum, between the leaflets of the tricuspid valve. The aortic valve was bicuspid, with the aneurysm originating from the right sinus of Valsalva. We presume that the bicuspid aortic valve tends to cause the sinus of Valsalva aneurysm in point that each coronary sinus is given excessive pressure compared with that in the normal aortic valve. Rarity of the combined cases is possibly because the bicuspid aortic valve is frequent while the sinus of Valsalva aneurysm is rare in Western countries and vice versa in Japan.

Adult↗
PubMed1998

Congenital bicuspid aortic valve: analysis of 63 surgical cases.

BACKGROUND AND AIMS OF THE STUDY: This study reports the clinicopathologic characteristics of congenital bicuspid aortic valves necessitating surgical intervention. METHODS: Among 374 aortic valve procedures during the past 15 years, 63 cases of bicuspid aortic valve were encountered. Patients included 45 males and 18 females; mean age was 53 years (range: 14 to 76 years). RESULTS: Thirty-two patients demonstrated aortic stenosis (AS), 27 aortic regurgitation (AR), and four had both conditions. Patients with AR were significantly younger than those with AS (45 +/- 13 versus 60 +/- 11 years; p < 0.01). Histologic study of the excised valve disclosed severe myxoid degeneration in 16 of 27 patients with AR. These patients underwent surgery at a younger age than the other 11 with calcification and endocarditis (40 +/- 13 versus 52 +/- 10 years; p = 0.01). Based on the macroscopic appearance, the lesions were divided into those with (n = 38) and without (n = 25) raphe. Twenty-one patients (55%) in the former group demonstrated AR, whereas 19 (76%) in the latter group demonstrated AS. Patients with raphe were significantly younger at the time of surgery than those without raphe (50 +/- 15 versus 57 +/- 11 years; p = 0.02). As a complication, ascending aortic aneurysm was observed in six patients. CONCLUSIONS: In a bicuspid aortic valve, calcification with stenosis commonly occurs in most older patients. However, in some young adult patients with raphe, AR may result from myxoid degeneration. The presence of raphe in the bicuspid valve appears to have a significant influence on valve hemodynamics.

Adolescent↗
PubMedDate not supplied

Management of a gunshot wound to the face resulting in a mandibular body fracture with burying of a bicuspid crown into the tongue.

Gunshot wounds to the maxillofacial region are unpredictable and run the gamut from minor injuries to severe mutilating and life threatening injuries. This patient although unfortunate to have been the victim of mistaken identify resulting in the gunshot wound, was fortunate that the bullet hit his bicuspid, which probably served to deflect its path away from vital structures, thus saving his life. This accounts for the buried bicuspid crown found in the midline of the body of the tongue. Rigid internal fixation of maxillofacial fractures minimizes risks to the airway that may occur if patients are in post-operative maxillo-mandibular fixation during the post-anesthetic recovery phase. In addition, the use of rigid internal fixation speeds up the recovery and the patient's ability to return to function after surgery. Above, we presented an interesting case of a mandibular anterior body fracture resulting from a gunshot wound in the face and resulting in the burying of a bicuspid crown in the substance of the tongue, treated under general nasoendotracheal anesthesia and the use of rigid internal fixation (EDCP).

Adult↗
PubMed2003

Prediction of the size of un-erupted permanent cuspids and bicuspids in a Saudi sample: a pilot study.

The purpose of this study was to produce an estimated equation for the prediction of unerupted cuspids and bicuspids for the Saudi population. In this study, dental casts of 65 Saudi subjects (37 males and 28 females) were used. The subjects' age ranged from 18 to 25 years. The mesiodistal width of all permanent teeth was measured. The data was subjected to regression analysis. Results showed the Tanaka and Johnston equations overestimate the predicted tooth width of the un-erupted cuspids and bicuspids in Saudis. Results showed the predicted tooth width of Saudis (males and females) is closer to the 50% level of confidence in Moyer's chart. Multiple regression equations were estimated including the sex factor. Accordingly, two equations were estimated for the prediction of the tooth width of the un-erupted cuspids and bicuspids for the Saudi males and females. Based on the results, it can be concluded the 50% data is more accurate than the commonly used percentage Moyer's table (75%) when both sexes are combined. Further studies are needed to confirm the findings of this study.

Adolescent↗
PubMed1991

Bicuspid buildup (convertible) splint.

All clinicians using removable repositioning orthotics are faced with the dilemma of lack of patient compliance. The author has solved this problem by using a maxillary appliance with an anterior inclined plane with intraocclusal acrylic in the bicuspid area. After mandibular reposturing is accomplished, the inclined plane can be removed, thus converting the appliance to a bicuspid buildup splint. This conversion creates an appliance that is esthetic and allows for normal phonation and a new bicuspid-only centric occlusion.

Bicuspid↗
PubMed1989

[The finite element analysis of the bicuspid and molar of mandible].

Recently, the finite element method has been adopted in the study of tooth structure as well as the stress distribution of dental prosthesis. In order to understand the loading state of the supporting tissues and the stress distribution of the teeth in various shapes under the pressure of loading, the author of this essay has applied the two-dimensional finite element method to the study of the stress distribution of the periodontal supporting tissues at the time when the second bicuspid and the second molar are vertically and obliquely loaded. Finally, the results of the quantitative analysis are obtained and a curve of the stress distribution of the teeth is also drawn up. The conclusion is as follows: 1. When the vertical loading is applied to the occlusal surface of the bicuspid and molar, the stress distribution of periodontal supporting tissues is uniform. 2. The stress concentration is on the marginal ridge and thedistal apex of bicuspid under the oblique loading. 3. When the oblique loading is applied to the occlusal surface of the molar, the stress concentration is only on the marginal ridge, and it is small.

Alveolar Process↗
PubMedDate not supplied

Coronary artery anomalies and bicuspid aortic valves in the Syrian hamster.

The condition of coronary arteries and aortic valves was studied in 552 Syrian hamsters belonging to a single family subjected to high endogamous pressure. The study was carried out using a corrosion-cast technique. In 178 hamsters the aortic valve was bicuspid. In 138 specimens, 54 of them with normal aortic valves and 84 with bicuspid aortic valves, anomalies in the origin of the coronary arteries could be classified in three morphologic types: left coronary artery from the pulmonary trunk (36 cases); single right coronary artery (84 cases); left coronary artery from the dorsal aortic sinus (18 cases). Results of a chi 2 contingency test show that the frequency of left coronary artery from the pulmonary trunk and single right coronary artery significantly increases when the aortic valve is bicuspid. The present findings suggest that there is a developmental complex consisting of biscuspid aortic valve and anomalous origin of the coronary arteries.

Animals↗
PubMed1998

Surgery for aortic dissection associated with congenital bicuspid aortic valve.

Congenital bicuspid aortic valve is a relatively rare malformation. It is reported that the presence of this anomaly predisposes the patient to the development of dissecting aortic aneurysms. Between 1981 and October 1997, 7 patients with aortic dissection associated with congenital bicuspid aortic valve underwent surgical treatment at our institution. The patients consisted of six males and one female. The age of the patients ranged from 54 to 74 years (mean 61 years). The classification of dissecting aortic aneurysms was DeBakey type I dissection in 4 patients, type II dissection in 2 patients and type IIIb dissection in 1 patient. These 7 patients constituted 2.0% (7/356) of all cases of surgical operation for dissecting thoracic aneurysm. Aortic valve dysfunction was noted in 5 patients, 4 of whom had previously undergone aortic valve replacement. We performed graft replacement of the ascending aorta in 4 patients, graft replacement of the ascending aorta and aortic arch in 2 patients, and graft replacement of the descending aorta in 1 patient. There were no hospital deaths in any of the 7 patients. Pathological examination of surgical specimens of the aortic wall showed cystic medial necrosis in 2 patients and mucoid degeneration in 4 patients. In addition to complication by valve dysfunction, patients with congenital bicuspid aortic valve are at risk for the development of aortic dissection.

Aged↗