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Perforation of a Stenotic Congenitally Bicuspid Aortic Valve Cusp by Heavy Calcium in the Other Cusp

William C Roberts1, Ishani Kale2, Charles S Roberts3

  • 1Baylor Scott & White Heart and Vascular Institute, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas; Departments of Internal Medicine (Division of Cardiology), Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas.

The American Journal of Cardiology
|December 19, 2019
PubMed

Insights

Heavy calcification in one cusp of bicuspid aortic valves (BAVs) can cause spurs that perforate the opposing cusp. This finding is crucial for understanding BAV disease progression and surgical interventions.

Area of Science:

  • Cardiovascular Medicine
  • Cardiac Surgery
  • Pathology

Background:

  • Congenitally bicuspid aortic valves (BAVs) are prone to stenosis and calcification.
  • Asymmetric calcification, where one cusp has significantly more calcium than the other, is observed in some BAV patients.

Purpose of the Study:

  • To investigate the relationship between asymmetric calcification in stenotic BAVs and cusp perforation.
  • To examine the mechanism by which heavy calcific deposits in one cusp affect the opposing cusp.

Main Methods:

  • Analysis of 630 operatively excised stenotic congenitally BAVs from patients undergoing isolated aortic valve replacement.
  • Exclusion of patients with prior infective endocarditis or other cardiac valve replacements.

Main Results:

  • Three out of 630 BAVs (0.48%) exhibited cusp perforation.
  • Perforations occurred in mildly calcified cusps due to calcific spurs originating from heavily calcified opposing cusps.

Conclusions:

  • Heavy calcific deposits in one cusp of a bicuspid aortic valve can extend across the aortic orifice.
  • These calcific spurs can lead to perforation of the noncalcified portion of the opposing cusp, highlighting a specific complication of asymmetric calcification in BAVs.

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