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Review
. 2022 Feb 8:8:798949.
doi: 10.3389/fcvm.2021.798949. eCollection 2021.

Bicuspid Aortic Valve Stenosis: From Pathophysiological Mechanism, Imaging Diagnosis, to Clinical Treatment Methods

Nils Perrin  1   2 , Réda Ibrahim  1 , Nicolas Dürrleman  1 , Arsène Basmadjian  1 , Lionel Leroux  3 , Philippe Demers  1 , Thomas Modine  3 , Walid Ben Ali  1
Affiliations
Review

Bicuspid Aortic Valve Stenosis: From Pathophysiological Mechanism, Imaging Diagnosis, to Clinical Treatment Methods

Nils Perrin et al. Front Cardiovasc Med. .

Abstract

Bicuspid aortic valve (BAV) is the most frequent congenital anomaly and has a natural evolution toward aortic regurgitation or stenosis due to the asymmetrical valve function associated with an evolutive ascending aortopathy. Several BAV classifications exist describing the presence and number of raphe, amount and location of calcium, and the symmetry of the functional cusps. The impact of BAV morphology on transcatheter aortic valve implantation (TAVI) outcomes still remains little investigated. Pivotal randomized trials comparing TAVI with surgery have excluded BAV until yet. However, data from registries and observational studies including highly selected patients have shown promising results of TAVI in BAV. With this review, we aimed at describing anatomical and pathophysiological characteristics of BAV, discussing the main aspects to assess diagnostic imaging modalities, and giving an overview of TAVI outcomes and technical considerations specific to BAV morphology.

Keywords: bicuspid aortic valve stenosis bicuspid aortic valve; nomenclature; review; sizing approaches; transcatheter aortic valve implantation.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The 2021 international consensus statement on nomenclature and classification of BAV (13).
Figure 2
Figure 2
Bicuspid aortic valve classification in the TAVI era (14).
Figure 3
Figure 3
Recommended prosthesis sizing according to the aortic root morphology in BAVs.
Figure 4
Figure 4
Treatment algorithm of patients with symptomatic severe BAV stenosis.
See this image and copyright information in PMC

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