Ebook ASE''s Comprehensive echocardiography textbook (2nd edition): Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook ASE''s Comprehensive echocardiography textbook (2nd edition): Part 2
Ebook ASE''s Comprehensive echocardiography textbook (2nd edition): Part 2
SectionXV Aortic Stenosis94Aortic Stenosis MorphologySteven A. Goldstein, MDCONGENITAL AORTIC STENOSISBicuspid Aortic ValveCongenital aortic valve mal Ebook ASE''s Comprehensive echocardiography textbook (2nd edition): Part 2lformation reflects a phenotypic continuum of unicuspid valve (severe form). bicuspid valve (moderate form I. tricuspid valve (normal, but may be abnormal}, and the rare quadncuspid forms Bicuspid aortic valves (BAY’S) are the result of abnormal cusp formation during the complex developmental proces Ebook ASE''s Comprehensive echocardiography textbook (2nd edition): Part 2s In most cases, adjacent cusps fail to separate, resulting in one larger conjoined cusp and a smaller one Therefore. BAV (or bicomnussural aortic valEbook ASE''s Comprehensive echocardiography textbook (2nd edition): Part 2
ve) has partial or complete fiision of two of die aortic valve leaflets, with or without a central raphe, resulting in partial or complete absence of SectionXV Aortic Stenosis94Aortic Stenosis MorphologySteven A. Goldstein, MDCONGENITAL AORTIC STENOSISBicuspid Aortic ValveCongenital aortic valve mal Ebook ASE''s Comprehensive echocardiography textbook (2nd edition): Part 2 common congenital heart defect. Information on the prevalence of BAV comes primarily from pathology centers.1- Valvular aortic stenosis (AS), a chronic progressive disease, usually develops over decades Box 94 1 lists the most common etiologies of valvular AS. as illustrated in Figure 94 1 The majo Ebook ASE''s Comprehensive echocardiography textbook (2nd edition): Part 2rity of cases of AS are acquired and result from degenerative (calcific) changes in an anatomically normal trileaflet aortic valve that becomes graduaEbook ASE''s Comprehensive echocardiography textbook (2nd edition): Part 2
lly dysfunctional over time. Congenitally abnormal valves may be stenotic at birth but usually become dysfunctional during early adolescence or early SectionXV Aortic Stenosis94Aortic Stenosis MorphologySteven A. Goldstein, MDCONGENITAL AORTIC STENOSISBicuspid Aortic ValveCongenital aortic valve mal Ebook ASE''s Comprehensive echocardiography textbook (2nd edition): Part 2 less common than in prior decades and is virtually always accompanied by mitral valve disease. Other forms of nonvalvular left ventricular outflow obsuuction (e.g.. discrete subvalve AS. hypertiophic cardiomyopathy, and supravalve AS) are discussed in other chapteis.The most reliable estimate of BA Ebook ASE''s Comprehensive echocardiography textbook (2nd edition): Part 2V prevalence is often considered to be die 1.37% reported by Larson and Edwards? Tile authors have a special expeitise in aortic valve disease and amaEbook ASE''s Comprehensive echocardiography textbook (2nd edition): Part 2
ssed 21.417 consecutive autopsies with 293 BAVs. An echocardiographic survey of primary school children demonstrated a BAV in 0.5% of males aiid 0.2% SectionXV Aortic Stenosis94Aortic Stenosis MorphologySteven A. Goldstein, MDCONGENITAL AORTIC STENOSISBicuspid Aortic ValveCongenital aortic valve mal Ebook ASE''s Comprehensive echocardiography textbook (2nd edition): Part 294.1 summarizes data on the prevalence of bicuspid valves. Bicuspid aortic valve is seen predominantly in males, with a 2:1 male-to-female ratio.’0-*2 Although BaV may occur in isolation, it may also be associated with other congenital cardiovascular malformations, including coarctation, patent duct Ebook ASE''s Comprehensive echocardiography textbook (2nd edition): Part 2us arteriosus, supravalve AS. atrial septal defect, ventncular septal defect, sinus of Valsalva aneurysm, and coronary artery anomalies There are alsoEbook ASE''s Comprehensive echocardiography textbook (2nd edition): Part 2
several syndromes in which BAV is a part of left-sided obstructive lesions of left ventricular inflow and outflow obstruction. including Shone syndroSectionXV Aortic Stenosis94Aortic Stenosis MorphologySteven A. Goldstein, MDCONGENITAL AORTIC STENOSISBicuspid Aortic ValveCongenital aortic valve mal Ebook ASE''s Comprehensive echocardiography textbook (2nd edition): Part 2ral History of Bicuspid Aortic ValvesAlthough a few patients with BAV may go undetected or without clinical consequences for a lifetime, most will develop complications The most important clinical consequences of BAV are valve stenosis, valve regurgitation, infective endocarditis, and aortic complic Ebook ASE''s Comprehensive echocardiography textbook (2nd edition): Part 2ations such as dilatation, dissection, and rapture (Box 94.2). Estimates of the prevalence of these complications and outcomes have varied depending oEbook ASE''s Comprehensive echocardiography textbook (2nd edition): Part 2
n the era of the study, the cohort selected, and the method used to diagnose BAV (clinical exam vs. cardiac catheterization vs. echocardiography). SevSectionXV Aortic Stenosis94Aortic Stenosis MorphologySteven A. Goldstein, MDCONGENITAL AORTIC STENOSISBicuspid Aortic ValveCongenital aortic valve mal Ebook ASE''s Comprehensive echocardiography textbook (2nd edition): Part 2tion of BAV, occurring in approximately 85% of all BAV cases.1 •18-21 Bicuspid aortic valve accounts for the majority of patients aged 15 to 65 years with significant AS. The progression of the congenitally deformed valve to AS presumably reflects its propensity for premature fibrosis, stiffening, a Ebook ASE''s Comprehensive echocardiography textbook (2nd edition): Part 2nd calcium deposition in these structurally abnormal valves.Aortic regurgitation, present in approximately 15% of patients with B AV.1 is usually dueEbook ASE''s Comprehensive echocardiography textbook (2nd edition): Part 2
to dilation of tire sinotubular junction of the aortic loot, preventing cusp coaptation. It may also be caused bycusp piolapse. fibrotic reu action ofSectionXV Aortic Stenosis94Aortic Stenosis MorphologySteven A. Goldstein, MDCONGENITAL AORTIC STENOSISBicuspid Aortic ValveCongenital aortic valve mal Ebook ASE''s Comprehensive echocardiography textbook (2nd edition): Part 2tients with a BaV develop stenosis and others regurgitation is not cleai. As mentioned, rarely, patients may not develop hemodynamics consequences. Roberts and colleagues reported three congenital BA Vs in nonagenarians who underwent surgery for AS.21 Why some patients with a congenital BAV do not b Ebook ASE''s Comprehensive echocardiography textbook (2nd edition): Part 2ecome symptomatic until they are in their 90s and why others become symptomatic in early life is also unclear.Echocardiographic Features of Bicuspid AEbook ASE''s Comprehensive echocardiography textbook (2nd edition): Part 2
ortic ValvesThe roles of echocardiography in the detection and evaluation are listed in Box 94.3. Tire diagnosis of a BAV can usually be made by transSectionXV Aortic Stenosis94Aortic Stenosis MorphologySteven A. Goldstein, MDCONGENITAL AORTIC STENOSISBicuspid Aortic ValveCongenital aortic valve mal Ebook ASE''s Comprehensive echocardiography textbook (2nd edition): Part 2rted for detecting BAV.22 -24 Tile most reliable and useful views are tile parasternal short-axis and long-axis views. The echocardiographic features and then respective views are summarized in Box 94.3. Tire parasternal short-axis view (SAX) is extremely useful to examine tire number and position o Ebook ASE''s Comprehensive echocardiography textbook (2nd edition): Part 2f the commissures, the opening pattern. the presence of a raphe, and the leaflet mobility. In contrast to the normal tricuspid aortic valve (TAV), whiEbook ASE''s Comprehensive echocardiography textbook (2nd edition): Part 2
ch opens m a triangular fashion with straightening of the leaflets (see Fig. 94.1; Fig 94.2. A), the BAV opens in an elliptical ("fish-mouth" or "footSectionXV Aortic Stenosis94Aortic Stenosis MorphologySteven A. Goldstein, MDCONGENITAL AORTIC STENOSISBicuspid Aortic ValveCongenital aortic valve mal Ebook ASE''s Comprehensive echocardiography textbook (2nd edition): Part 2re the cusps failed to separate :0‘ The raphe is usually distinct and generally extends from389390SECTION XV Acrtc StenoseBox 94.1 Aortic Stenosis: Etiology1.Congenital (unicuspid. bicuspid. Qjadnoicpidl2.Degenerative (sclerosis of previously normal valve)3.Rheumaticthe free m.irguv$ to the base of Ebook ASE''s Comprehensive echocardiography textbook (2nd edition): Part 2the leaflet. Calcification commonly occurs first along this raphe, ultimately hindering the motion of the conjoined cusp Rarely, the leaflets are symmEbook ASE''s Comprehensive echocardiography textbook (2nd edition): Part 2
etric and there is no raphe—a "pure" bicuspid valve. Note that a false-negative diagnosis may occur when the raphe gives the appearance of a third coaSectionXV Aortic Stenosis94Aortic Stenosis MorphologySteven A. Goldstein, MDCONGENITAL AORTIC STENOSISBicuspid Aortic ValveCongenital aortic valve mal Ebook ASE''s Comprehensive echocardiography textbook (2nd edition): Part 2clock (see Figs 94 1 and 94 .2,8). When the commissures are deviated from those clock-face position, one should suspect a BAV and evaluate carefully. An additional short-axis feature is a vanable degree of leaflet redundancy. In patients with very little redundancy of the leaflet margins, the develo Ebook ASE''s Comprehensive echocardiography textbook (2nd edition): Part 2pment of stenosis is likely, whereas a significantly redundant leaflet with associated prolapse is more likely to lead to regurgitationThe morphologicEbook ASE''s Comprehensive echocardiography textbook (2nd edition): Part 2
patterns of BAV vary according to which commissures have fused, and a number of classifications have been devised that pertain to the orientation of SectionXV Aortic Stenosis94Aortic Stenosis MorphologySteven A. Goldstein, MDCONGENITAL AORTIC STENOSISBicuspid Aortic ValveCongenital aortic valve mal Ebook ASE''s Comprehensive echocardiography textbook (2nd edition): Part 2randenburg and colleagues.-- the posterior commissure was located at 4 or 5 o'clock and the anterior commissure was located at 9 or 10 o'clock when the valve is viewed in a parasternal slioit-axis view. The second most frequent type, fusion of tire right and noncoronaiy cusps, has been linked to aor Ebook ASE''s Comprehensive echocardiography textbook (2nd edition): Part 2tic arch involvement50-55 and may also be related to an increased risk of AS and regurgitation compared with the other anatomic types.;' The least comEbook ASE''s Comprehensive echocardiography textbook (2nd edition): Part 2
mon type is fusion of the left and noDCOionary cusps? ‘ Miclreleua and colleagues similarly classified BA Vs as typical (right-left coronary cusp fusiSectionXV Aortic Stenosis94Aortic Stenosis MorphologySteven A. Goldstein, MDCONGENITAL AORTIC STENOSISBicuspid Aortic ValveCongenital aortic valve mal Ebook ASE''s Comprehensive echocardiography textbook (2nd edition): Part 2usion) if tire commissures were at 1 and 7 o'clock or 12 and 6 o'clock.19TABLE 94.1 Prevacoce of Bicuspid Aortic Vafces (8AV)AuthorYearBAV PrevalenceMethodReferenceWauchope192899960.5Autopsy2Gross193750000.56Autopsy3Larsen aid1964214171.37Autopsy4EdwardsDana et al196888030.59Autcpsy5Pai-peru19992000 Ebook ASE''s Comprehensive echocardiography textbook (2nd edition): Part 20.65Autopsy6etalBasso el á2W4»170.52O-echo8Mstnetal2005209460.82O-ecbo9Gọi ngay
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