Cerebral and Retinal Infarction in Bicuspid Aortic Valve

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Geoffrey D Huntley1, Hector I Michelena1, Jeremy J Thaden1

  • 1Department of Cardiovascular Medicine Mayo Clinic Rochester MN.

Journal of the American Heart Association
|March 21, 2023
PubMed

Insights

Cardioembolism from degenerative calcific bicuspid aortic valve (BAV) is a primary cause of recurrent cerebral and retinal infarction. These events are a recognized complication of BAV, necessitating careful patient management.

Area of Science:

  • Cardiology
  • Neurology
  • Vascular Medicine

Background:

  • Limited data exists on cerebral and retinal infarction in patients with bicuspid aortic valve (BAV).
  • Case reports are the primary source of information.
  • Characterizing these events and their outcomes in BAV patients is crucial.

Purpose of the Study:

  • To characterize cerebral and retinal infarction in patients with BAV.
  • To examine the outcomes associated with these infarctions.
  • To determine the pathogenesis and recurrence rates of infarction in BAV patients.

Main Methods:

  • Retrospective analysis of consecutive patients with BAV from 1975 to 2015.
  • Identification of patients with confirmed cerebral or retinal infarction (excluding those post-aortic valve replacement).
  • Classification of infarction into categories: embolism from degenerative calcific BAV (BAVi), non-BAV large artery atherosclerotic or lacunar infarction (LAi), and non-BAV, non-large artery embolic infarction (nLAi).

Main Results:

  • 1.5% (83/5401) of BAV patients experienced cerebral or retinal infarction.
  • Embolism accounted for 87% of infarctions, with 49% being cardioembolic.
  • Recurrent infarction occurred in 41% of patients, with BAVi showing a 50% recurrence rate. Retinal infarction was more common in BAVi.
  • BAVi and LAi patients were more likely to have moderate-to-severe aortic stenosis and undergo aortic valve replacement.

Conclusions:

  • Cardioembolism, frequently from degenerative calcific BAV, is a predominant cause of cerebral and retinal infarction in BAV patients.
  • These infarctions are often recurrent.
  • Cerebral and retinal infarction should be considered a complication of BAV.

Keywords:
aortic valve calcificationbicuspid aortic valvecerebral infarctionembolismretinal infarctionstroke

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