A Comprehensive Review of Management Strategies for Bicuspid Aortic Valve (BAV): Exploring Epidemiology, Aetiology, Aortopathy, and Interventions in Light of Recent Guidelines
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Published:2023-09-18
Issue:9
Volume:10
Page:398
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ISSN:2308-3425
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Container-title:Journal of Cardiovascular Development and Disease
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language:en
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Short-container-title:JCDD
Author:
Bulut Halil Ibrahim1ORCID, Arjomandi Rad Arian2ORCID, Syrengela Angeliki-Aikaterini3ORCID, Ttofi Iakovos4ORCID, Djordjevic Jasmina4, Kaur Ramanjit4, Keiralla Amar4, Krasopoulos George4ORCID
Affiliation:
1. Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul 34098, Turkey 2. Medical Sciences Division, University of Oxford, Oxford OX1 3AZ, UK 3. School of Medicine of Crete, 71500 Heraklion, Greece 4. Department of Cardiothoracic Surgery, Oxford University Hospital NHS Foundation Trust, Oxford OX3 9DU, UK
Abstract
Objective: bicuspid aortic valve (BAV) stands as the most prevalent congenital heart condition intricately linked to aortic pathologies encompassing aortic regurgitation (AR), aortic stenosis, aortic root dilation, and aortic dissection. The aetiology of BAV is notably intricate, involving a spectrum of genes and polymorphisms. Moreover, BAV lays the groundwork for an array of structural heart and aortic disorders, presenting varying degrees of severity. Establishing a tailored clinical approach amid this diverse range of BAV-related conditions is of utmost significance. In this comprehensive review, we delve into the epidemiology, aetiology, associated ailments, and clinical management of BAV, encompassing imaging to aortic surgery. Our exploration is guided by the perspectives of the aortic team, spanning six distinct guidelines. Methods: We conducted an exhaustive search across databases like PubMed, Ovid, Scopus, and Embase to extract relevant studies. Our review incorporates 84 references and integrates insights from six different guidelines to create a comprehensive clinical management section. Results: BAV presents complexities in its aetiology, with specific polymorphisms and gene disorders observed in groups with elevated BAV prevalence, contributing to increased susceptibility to other cardiovascular conditions. The altered hemodynamics inherent to BAV instigate adverse remodelling of the aorta and heart, thus fostering the development of epigenetically linked aortic and heart diseases. Employing TTE screening for first-degree relatives of BAV patients might be beneficial for disease tracking and enhancing clinical outcomes. While SAVR is the primary recommendation for indicated AVR in BAV, TAVR might be an option for certain patients endorsed by adept aortic teams. In addition, proficient teams can perform aortic valve repair for AR cases. Aortic surgery necessitates personalized evaluation, accounting for genetic makeup and risk factors. While the standard aortic replacement threshold stands at 55 mm, it may be tailored to 50 mm or even 45 mm based on patient-specific considerations. Conclusion: This review reiterates the significance of considering the multifactorial nature of BAV as well as the need for further research to be carried out in the field.
Subject
Pharmacology (medical),General Pharmacology, Toxicology and Pharmaceutics
Reference84 articles.
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