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The diagnosis of a non-stenotic bicuspid aortic valve
Insights
An isolated aortic ejection sound often indicates a non-stenotic bicuspid aortic valve. Echocardiography can confirm this diagnosis by visualizing abnormal aortic valve cusp motion.
Area of Science:
- Cardiology
- Echocardiography
- Valvular Heart Disease
Background:
- An aortic ejection sound, when isolated, has been associated with bicuspid aortic valves.
- Previous diagnostic methods relied on necropsy, operation, or less sensitive echocardiographic findings.
Purpose of the Study:
- To investigate the diagnostic utility of high-speed echophonocardiography for identifying non-stenotic bicuspid aortic valves based on isolated aortic ejection sounds.
- To correlate the timing of the ejection sound with aortic valve cusp dynamics.
Main Methods:
- Echophonocardiography was performed on subjects with known bicuspid aortic valves and aortic stenosis.
- Echocardiographic visualization of aortic valve cusp configuration and motion was assessed from the apex.
- 37 subjects with isolated aortic ejection sounds were evaluated using these echocardiographic techniques.
Main Results:
- The aortic ejection sound was synchronous with the final halting of opening aortic valve cusps in bicuspid valves.
- Abnormal cusp configuration visualized by echocardiography was a sensitive indicator of bicuspid aortic valves.
- 30 out of 37 subjects with isolated aortic ejection sounds were diagnosed with non-stenotic bicuspid aortic valves.
Conclusions:
- An isolated aortic ejection sound, without signs of stenosis, strongly suggests a non-stenotic bicuspid aortic valve.
- Echophonocardiography provides definitive confirmation of the aortic valvar origin of the ejection sound.
- Echocardiographic visualization of abnormal cusp configuration is superior to eccentric closure lines for diagnosing bicuspid aortic valves.
Abstract:
Follow-up of a group of subjects in whom an aortic ejection sound was the only abnormal finding revealed a bicuspid aortic valve at necropsy or operation in 6 cases. High speed echophonocardiographic studies in 15 subjects with aortic stenosis and known to have bicuspid valves, showed the ejection sound to be exactly synchronous with final halting of the opening aortic valve cusps. Echocardiographic visualisation of the aortic valve from the apex, looking up the left ventricular outflow tract, showed valve echoes during systole indicating abnormal cusp configuration. This proved a more sensitive indicator of a bicuspid aortic valve than the finding of an eccentric aortic valve closure line. These findings were used to evaluate 37 subjects with the auscultatory finding of an isolated aortic ejection sound and the diagnosis of a non-stenotic bicuspid aortic valve was confirmed in 30. The usual cause of misdiagnosis was a sound associated with late tricuspid valve closure. The auscultatory finding of an aortic ejection sound, in the absence of other signs of aortic stenosis, indicates a non-stenotic, bicuspid aortic valve. Confirmation of aortic valvar origin of the sound can be provided by a simultaneous echophonocardiogram.