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Valvular Heart Disease: Difference between revisions
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=== Clinical Presentation === | === Clinical Presentation === | ||
In infancy, bicuspid aortic valve disease is often asymptomatic. By adolescence an estimate 1 of 50 children born with these abnormalities will have clinically significant obstruction or regurgitation. <cite> | In infancy, bicuspid aortic valve disease is often asymptomatic. By adolescence an estimate 1 of 50 children born with these abnormalities will have clinically significant obstruction or regurgitation. <cite>Bonow2</cite> | ||
Complications of bicuspid aortic valve disease are common in adulthood <cite>Tzemos</cite>. The abnormal shear stress leads to valve calcification and further aortic root dilation has been reported. <cite> | Complications of bicuspid aortic valve disease are common in adulthood <cite>Tzemos</cite>. The abnormal shear stress leads to valve calcification and further aortic root dilation has been reported. <cite>Bonow3/cite> The most common complication is aortic stenosis, caused by premature fibrosis, stiffening, and calcium deposition. The majority of patients under 65 years of age with significant aortic valve stenosis have bicuspid aortic valve disease. A more rare complication of bicuspid aortic valve disease is aortic regurgitation. 15% of all cases of aortic regurgitation in the Euro Heart survey had bicuspid aortic valve disease. On auscultation, an ejection sound can be audible, best heard at the apex. There may be associated murmurs of aortic stenosis, incompetence, or coarctation of the aorta when these lesions are present. | ||
=== Diagnostic options === | === Diagnostic options === | ||
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Indications for valvuloplasty in children include peak-to peak gradients >50 mm Hg with ST- or T-wave changes at rest or with exercise. Valvuloplasty is also indicated for symptomatic children with peak-to-peak gradients >60 mm Hg. <cite>Warnes</cite> | Indications for valvuloplasty in children include peak-to peak gradients >50 mm Hg with ST- or T-wave changes at rest or with exercise. Valvuloplasty is also indicated for symptomatic children with peak-to-peak gradients >60 mm Hg. <cite>Warnes</cite> | ||
Surgical options for adult bicuspic aortic valve disease include valve replacement (bioprosthetic or mechanical valves), Ross procedure or valve repair (for those with aortic incompetence) Surgical aortic valve replacement is the most common procedure in adults with bicuspid aortic valve disease, for either aortic valve stenosis or regurgitation. Indications of interventions are similar to those described for tricuspid aortic valve disease in the ACC/AHA guidelines for the management of patients with valvular heart disease. <cite> | Surgical options for adult bicuspic aortic valve disease include valve replacement (bioprosthetic or mechanical valves), Ross procedure or valve repair (for those with aortic incompetence) Surgical aortic valve replacement is the most common procedure in adults with bicuspid aortic valve disease, for either aortic valve stenosis or regurgitation. Indications of interventions are similar to those described for tricuspid aortic valve disease in the ACC/AHA guidelines for the management of patients with valvular heart disease. <cite>Bonow3</cite> | ||
Approximately 30% of adults with bicuspid aortic valve disease undergoing aortic valve replacement will also need aortic root surgery. Surgical attention for dimensions of the aortic root is essential because of the risk of further root dilation. The ascending aorta in patients with bicuspid aortic valve disease increases 0.2 to 1.2 mm/year. <cite>Thanassoulis</cite> | |||
Guidelines suggest that changes in root size more than 0.5 cm/year are an indication for root replacement. Aortic root dimensions of 5.0 cm require intervention and aortic root dimensions of 4.5 cm require intervention if surgery is performed for valvular indications according to current guidelines. | |||
=== Prognosis === | |||
Life expectancy in adult patients with bicuspid aortic valve disease is not shortened when compared | |||
with the general population. 10-year survival in asymptomatic adults with bicuspid aortic valve disease with a spectrum of valve function, was 96% <cite>Tzemos</cite>. In asymptomatic adults with bicuspid aortic valve disease without significant valve dysfunction the 20-year survival was 90%. <cite>Michelena</cite> | |||