scholarly journals Native Aortic Valve Endocarditis Complicated by Splenic Infarction and Giant Mitral-Aortic Intervalvular Fibrosa Pseudoaneurysm—A Case Report and Brief Review of the Literature

Diagnostics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 251
Author(s):  
Andreea Varga ◽  
Ioan Tilea ◽  
Cristina Maria Tatar ◽  
Dragos Gabriel Iancu ◽  
Maria Andrada Jiga ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Aortic Valve Disease ◽  
Multimodality Imaging ◽  
Fatal Outcome ◽  
Left Ventricular ◽  
Splenic Infarction ◽  
Valve Disease ◽  
Unusual Complication

Background: Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (P-MAIVF) is an unusual complication related to various injuries or conditions which involve the mitro-aortic region; it communicates with the left ventricular outflow tract and is associated with a high-risk of redoubtable complications or sudden death. The cerebral and splenic localizations are frequently seen as manifestations of systemic embolism in infective endocarditis. Currently, there are no specific recommendations related to the diagnosis, management, treatment, or further evolution of patients with P-MAIVF and concomitant splenic infarction. This paper presents the case of a 43-year-old Caucasian woman with a late diagnosis of mixed bicuspid aortic valve disease, affected by an under-detected and undertreated episode of infective endocarditis leading to asymptomatic P-MAIVF. Prime clinical and imagistic diagnosis of splenic infarction indicated further extended investigations were required to clarify the source of embolism. Methods: Integrated multimodality imaging techniques confirmed the unexpected diagnosis of P-MAIVF. Results: The case had a fatal outcome following an uncomplicated yet laborious cardiac surgery. Patient death was attributed to a malignant ventricular arrhythmia. Conclusion: The present case raises awareness by highlighting an unexplained and unexpected splenic infarction association with P-MAIVF as a result of infective endocarditis related to mixed bicuspid aortic valve disease.

Abstract 15609: Risk of Aortic Valve Disease and Aortopathy in Patients With Bicuspid Aortic Valve Referred to a Central County Hospital in Denmark

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Kristina Procida ◽  
Riina Oksjoki ◽  
Sandra Wulffeld ◽  
Dorthe Guldbrand Nielsen ◽  
Soren Schmiegelow ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Aortic Valve Disease ◽  
Left Ventricular ◽  
Valve Disease ◽  
Left Ventricular Ejection ◽  
Aortic Valve Area ◽  
Ventricular Ejection Fraction

Introduction: Patients with bicuspid aortic valve (BAV) are at increased risk of developing severe aortic valve disease and aortopathy at an early age. We therefore performed a retrospective study to describe all patients diagnosed with BAV in an entire region of Denmark. Methods: We included patients≥18 years old with BAV, who had a transthoracic echocardiography (TTE) at our hospital before May 2020, and through electronic health records and our echocardiography database, we achieved baseline data. Results: A total of 545 patients with BAV (74.1% men) were identified. At the time of BAV diagnosis the median age was 54 years (IQR 42-62), and the causes for referral to TTE were primarily chest discomfort (21.1%), dyspnea (17.6%), or a newly discovered murmur (40.0%). Upon diagnosis 19.3% of the patients had an aortic valve area (AVA)<1,0 cm 2 , 2.4% had severe aortic regurgitation and the majority (84.0%) had normal left ventricular ejection fraction. The ascending aorta was dilated in 51.9% of the patients while aortic coarctation was found in 5.1% of all patients. According to Sievers BAV classification 24.4% (N=133) had Type 0, 58.7% (N=320) had Type 1 left/right(L/R) fusion, 10.6% (N=58) had Type 1 right/noncoronary (R/N) fusion, 2.6% (N=14) had Type 1 left/noncoronary (L/N) fusion and 2.2% (N=12) had Type 2. Coexisting diabetes mellitus (10.1%), ischemic heart disease (13.2%) and chronic obstructive pulmonary disease (10.1%) was low, whereas hypertension was frequent (47.9%). The majority had sinus rhythm (75.6%) and normal eGFR (84.4%). Surgery was performed in 37.3% (N=203) of all patients and primarily due to aortic valve stenosis (N=172, 84.7%). Surgery was performed in a higher frequency of patients with Sievers Type 1 L/N fusion (N=9, 4.4%; 64.3% of all Type 1 L/N) and Type 2 (N=10, 4.9%, 83.3% of all Type 2) and lowest in patients with Sievers Type 0 (N=35, 17.2%; 26.3% of all Type 0). However, likelihood of surgery was only significantly different between patients with BAV Type 2 and Type 1 L/R (OR 14.21 (2.83-71.35). Conclusion: In this cohort of patients with BAV a higher fraction of patients with BAV type 1 L/N and BAV type 2 required valve replacement compared with particularly BAV type 0 suggesting important differences according to BAV subtype.

Advances in Transcatheter Aortic Valve Therapy in Bicuspid Aortic Valve Disease: Insight into Patient Selection, Management, and Future Directions

2021 ◽  
Vol 39 ◽  
Author(s):  
Valeria Cammalleri ◽  
◽  
Gianpaolo Ussia ◽  
Mario Lusini ◽  
Ciro Mastroianni ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Bicuspid Aortic Valve ◽  
Aortic Valve Disease ◽  
Multimodality Imaging ◽  
Valve Disease ◽  
Transcatheter Aortic Valve ◽  
Transcatheter Valve

Bicuspid aortic valve (BAV) disease is the most common congenital abnormality and is characterized by a risk of premature aortic valve disease, predominantly aortic stenosis. Surgery remains the treatment of choice for patients with symptomatic BAV disease, but, in patients who are unsuitable for surgical aortic valve replacement, transcatheter aortic valve replacement (TAVR) is currently used as an alternative to surgery, although there is no official recommendation for their management, since BAV patients with severe aortic stenosis have been excluded from the major TAVR randomized clinical trials. Patients with BAV stenosis present anatomic challenges for treatment with TAVR. The BAV annulus often has an elliptical shape and is larger than the tricuspid valve, and is more likely to exhibit severe eccentric calcification. In addition, BAV is often associated with a dilated, horizontal ascending aorta, and effaced sinuses. The calcified raphe may also place differential stress on the expansion of the transcatheter valve, increasing the risk of suboptimal positioning and consequently the risk of paravalvular leakage, new pacemaker implantation, new-onset left bundle branch block, and annular rupture. Moreover, coronary obstruction may occur when leaflet fusion results in a longer leaflet. Although some of these challenges have been successfully overcome using new-generation devices, the complication rate is still relatively high and requires a deeper understanding of the patient’s specific complex and variable anatomy. Selection of the type and size of the transcatheter valve according to the patient’s individual anatomy is critical to achieving successful results. Therefore, given the increasing frequency of BAV stenosis in younger patients, and the worldwide expansion in the application of TAVR in younger and lower surgical-risk patients, preprocedural multimodality imaging involving CT scan and three-dimensional echocardiography is mandatory to understand the complex and variable anatomy of BAV disease and improve both procedural results and short- and long-term outcomes in these patients.

scholarly journals RISK FACTORS FOR INFECTIVE ENDOCARDITIS IN SURGICAL PATIENTS WITH BICUSPID AORTIC VALVE DISEASE

2016 ◽  
Vol 67 (13) ◽  
pp. 967 ◽  
Author(s):  
Dillon Schafer ◽  
Alexander Taylor ◽  
Adin-Cristian Andrei ◽  
Zhi Li ◽  
Colleen Clennon ◽  
...  
Keyword(s):  
Risk Factors ◽  
Infective Endocarditis ◽  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Aortic Valve Disease ◽  
Valve Disease ◽  
Surgical Patients

Collagen analysis of the ascending aortic dilatation associated with bicuspid aortic valve disease compared with tricuspid aortic valve

2016 ◽  
Vol 122 (5) ◽  
pp. 289-294 ◽  
Author(s):  
Alexander Navarrete Santos ◽  
Junfeng Yan ◽  
Peter Lochmann ◽  
Heike Pfeil ◽  
Michael Petersen ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Aortic Valve Disease ◽  
Valve Disease ◽  
Aortic Dilatation ◽  
Tricuspid Aortic Valve ◽  
Collagen Analysis
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