Nappi Francesco, Avtaar Singh Sanjeet Singh, de Siena Paolo M
Department of Cardiac Surgery, Centre Cardiologique du Nord, 93200 Saint-Denis, France.
Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK.
J Cardiovasc Dev Dis. 2024 Oct 11;11(10):317. doi: 10.3390/jcdd11100317.
Bicuspid aortic valve disease is the most prevalent congenital heart disease, affecting up to 2% of the general population. The presentation of symptoms may vary based on the patient's anatomy of fusion, with transthoracic echocardiography being the primary diagnostic tool. Bicuspid aortic valves may also appear with concomitant aortopathy, featuring fundamental structural changes which can lead to valve dysfunction and/or aortic dilatation over time. This article seeks to give a comprehensive overview of the presentation, treatment possibilities and long-term effects of this condition. The databases MEDLINE, Embase, and the Cochrane Library were searched using the terms "endocarditis" or "bicuspid aortic valve" in combination with "epidemiology", "pathogenesis", "manifestations", "imaging", "treatment", or "surgery" to retrieve relevant articles. We have identified two types of bicuspid aortic valve disease: aortic stenosis and aortic regurgitation. Valve replacement or repair is often necessary. Patients need to be informed about the benefits and drawbacks of different valve substitutes, particularly with regard to life-long anticoagulation and female patients of childbearing age. Depending on the expertise of the surgeon and institution, the Ross procedure may be a viable alternative. Management of these patients should take into account the likelihood of somatic growth, risk of re-intervention, and anticoagulation risks that are specific to the patient, alongside the expertise of the surgeon or centre. Further research is required on the secondary prevention of patients with bicuspid aortic valve (BAV), such as lifestyle advice and antibiotics to prevent infections, as the guidelines are unclear and lack strong evidence.
二叶式主动脉瓣疾病是最常见的先天性心脏病，影响着高达2%的普通人群。症状表现可能因患者融合的解剖结构而异，经胸超声心动图是主要的诊断工具。二叶式主动脉瓣也可能伴有主动脉病变，其特征是基本结构改变，随着时间的推移可导致瓣膜功能障碍和/或主动脉扩张。本文旨在全面概述这种疾病的表现、治疗可能性和长期影响。使用“心内膜炎”或“二叶式主动脉瓣”与“流行病学”“发病机制”“表现”“影像学”“治疗”或“手术”相结合的检索词，对MEDLINE、Embase和Cochrane图书馆数据库进行检索，以获取相关文章。我们确定了两种类型的二叶式主动脉瓣疾病：主动脉狭窄和主动脉反流。通常需要进行瓣膜置换或修复。需要告知患者不同瓣膜替代品的利弊，特别是关于终身抗凝以及育龄女性患者的情况。根据外科医生和机构的专业知识，罗斯手术可能是一种可行的选择。对这些患者的管理应考虑到身体生长的可能性、再次干预的风险以及患者特有的抗凝风险，同时还要考虑外科医生或中心的专业知识。由于指南不明确且缺乏有力证据，对于二叶式主动脉瓣（BAV）患者的二级预防，如生活方式建议和预防感染的抗生素，还需要进一步研究。
