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Michelena et al
Surgical events
Michelena et al
The largest study (n=642) in symptomatic/asymptomatic BAV pts:
10-year 96% survival
Michelena et al
Similar to normal population
Independent predictors of primary cardiac events:
Age ≥30 yrs Michelena et al
Moderate/Severe AS
Moderate/Severe AR
BAV- Aortopathy
Prevalence of tubular ascending aorta dilation increases with age:
<30 yrs 30-39yrs 40-49yrs 50-60yrs >60yrs
56% 74% 85% 91% 88%
Pathophysiology
Genetic evidence
Aortopathy prevalent in 1st degree relatives of BAV pts
Aortic dimension differences in BAV of controls in spite of
haemodynamic variable adjustments
Aortic dilation in BAVs (incl. children) without AS/AR
Progressive aortic dilation with or without AVR
Haemodynamic evidence
Recent MRI studies -
Abnormal transvalvular-flow patterns despite apparent normally functioning
BAVs
Regional increases in wall-shear stress
Diagnosis
ECHO
Sensitivity 92%, Specificity 96%
Raphe
Findings:
Raphe
Systolic doming & eccentric
closure line(LAX)
Evaluate in systole; raphe may
Doming
appear trileaflet
MRI
Management
Surveillance
Class I [AHA]
Annual aortic imaging if
Aortic dilation >4.5 cm
Rapid rate of change in aortic diameter
Family history of dissection
Screening
First-degree family members of pts with BAV
Medical
Repair of BAV
When to consider:
Regurgitant valves
Pliable leaflets
Minimal fibrosis/calcification
No more than mild cusp thickening
Minor fenestrations
Effective height: Height to which central free margin of cusp rises
over the aortic insertion line of cusp
N = 9-10mm
Prolapse: <6-7mm
Restore cusp integrity- Closing tears/perforations by direct suture or
autologous pericardial patching
Line-up discloses presence of tissue redundancy