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Journal of Molecular and Cellular... Apr 2019Bicuspid aortic valve (BAV) is recognized as a syndrome including aortic valve diseases and aortic wall alterations, such as aortic dilatation, dissection and rupture,... (Review)
Review
Bicuspid aortic valve (BAV) is recognized as a syndrome including aortic valve diseases and aortic wall alterations, such as aortic dilatation, dissection and rupture, but also coronary atherosclerosis. The current evidence, although partially controversial, suggests that several molecular mechanisms promoting atherosclerosis are activated in BAV patients and are involved in the progression of the related diseases, from aortic stenosis to aortopathies, along with altered hemodynamics. Among these factors, dyslipidemia (i.e., high LDL cholesterol, high lipoprotein (a)) and the activation of specific pro-inflammatory pathways (nucleotide-binding oligomerization domain-like receptor containing pyrin domain 3 inflammasome and Toll-like receptor 4) appear to play a pivotal role in the progression of BAV-associated diseases. The further elucidation of such molecular mechanisms may lead to a better and personalized prognosis and follow-up for BAV patients and suggest novel pharmacological approaches to prevent disease progression.
Topics: Animals; Aortic Valve; Atherosclerosis; Bicuspid Aortic Valve Disease; Heart Valve Diseases; Humans; Inflammation; Lipid Metabolism; Lipoprotein(a); Vasodilation
PubMed: 30872037
DOI: 10.1016/j.yjmcc.2019.03.004 -
Current Opinion in Cardiology Nov 2015Bicuspid aortic valve stenosis is regarded as a relative contraindication for transcatheter aortic valve replacement (TAVR) according to current guidelines, as patients... (Review)
Review
PURPOSE OF REVIEW
Bicuspid aortic valve stenosis is regarded as a relative contraindication for transcatheter aortic valve replacement (TAVR) according to current guidelines, as patients with bicuspid anatomy (BiAV) were excluded from landmark clinical trials.In this review, we will discuss the feasibilty, safety and outcomes of TAVR in BiAV, based upon the current literature and our own experience.
RECENT FINDINGS
The currently available data come from observational registries with low sample size, and only in a few were the results of TAVR in BiAV compared with those achieved in the cohort with tricuspid anatomy. TAVR proved to be technically feasible in selected BiAV patients, and the mid-term clinical outcomes are acceptable. Nevertheless, there are still some unresolved issues, such as long-term valve durability and the relatively high rate of paravalvular leakage.
SUMMARY
The existing literature supports the use of TAVR in selected high-risk BiAV patients, although the final role of this technique in this cohort of patients can only be established once a larger, preferably randomized, study comparing TAVR with surgery is performed.
Topics: Aortic Valve; Bicuspid Aortic Valve Disease; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Prosthesis Design; Transcatheter Aortic Valve Replacement
PubMed: 26398414
DOI: 10.1097/HCO.0000000000000219 -
JACC. Cardiovascular Imaging May 2024
Topics: Humans; Aortic Valve Stenosis; Aortic Valve; Calcinosis; Risk Factors; Time Factors; Risk Assessment; Prognosis; Predictive Value of Tests
PubMed: 38719393
DOI: 10.1016/j.jcmg.2024.02.018 -
Engineering the aortic valve extracellular matrix through stages of development, aging, and disease.Journal of Molecular and Cellular... Dec 2021For such a thin tissue, the aortic valve possesses an exquisitely complex, multi-layered extracellular matrix (ECM), and disruptions to this structure constitute one of... (Review)
Review
For such a thin tissue, the aortic valve possesses an exquisitely complex, multi-layered extracellular matrix (ECM), and disruptions to this structure constitute one of the earliest hallmarks of fibrocalcific aortic valve disease (CAVD). The native valve structure provides a challenging target for engineers to mimic, but the development of advanced, ECM-based scaffolds may enable mechanistic and therapeutic discoveries that are not feasible in other culture or in vivo platforms. This review first discusses the ECM changes that occur during heart valve development, normal aging, onset of early-stage disease, and progression to late-stage disease. We then provide an overview of the bottom-up tissue engineering strategies that have been used to mimic the valvular ECM, and opportunities for advancement in these areas.
Topics: Aging; Animals; Aortic Valve; Aortic Valve Stenosis; Calcinosis; Extracellular Matrix; Humans; Tissue Engineering; Tissue Scaffolds
PubMed: 34339757
DOI: 10.1016/j.yjmcc.2021.07.009 -
Journal of the American College of... Aug 2021
Topics: Aortic Valve; Heart Valve Diseases; Humans; Thrombosis
PubMed: 34412816
DOI: 10.1016/j.jacc.2021.06.025 -
The Journal of Thoracic and... Jul 2021
Topics: Aortic Valve; Aortic Valve Stenosis; Heart Valve Prosthesis; Humans; Tricuspid Valve Insufficiency
PubMed: 32245666
DOI: 10.1016/j.jtcvs.2020.02.097 -
The American Journal of Medicine Aug 2016Although bicuspid aortic valve is the most common congenital abnormality, it is perhaps erroneous to consider this disease one clinical entity. Rather, it may be useful... (Review)
Review
Although bicuspid aortic valve is the most common congenital abnormality, it is perhaps erroneous to consider this disease one clinical entity. Rather, it may be useful to consider it a cluster of diseases incorporating different phenotypes, etiologies, and pathogenesis. Discussion of bicuspid aortic valve can be difficult because there is no clear consensus on a phenotypic description among authors, and many classification schemes have been proposed. The literature suggests that different phenotypes have different associations and clinical manifestations. In addition, recent studies suggest a genetic basis for the disease, yet few genes have so far been described. Furthermore, recent scientific literature has been focusing on the increased risk of aortic aneurysms, but the pathogenesis of bicuspid aortic valve aortopathy is still unclear. The aim of this paper is to review the current evidence about the unsolved issues around bicuspid aortic valve.
Topics: Animals; Aortic Diseases; Aortic Valve; Bicuspid Aortic Valve Disease; Genetic Predisposition to Disease; Heart Valve Diseases; Humans; Phenotype; Risk Factors
PubMed: 27059385
DOI: 10.1016/j.amjmed.2016.03.009 -
European Journal of Cardio-thoracic... Sep 2021
Topics: Aortic Valve; Bicuspid Aortic Valve Disease; Heart Valve Diseases; Humans
PubMed: 34292340
DOI: 10.1093/ejcts/ezab073 -
Journal of Cardiothoracic and Vascular... Nov 2022
Topics: Aortic Valve; Aortic Valve Insufficiency; Humans; Mitral Valve; Treatment Outcome
PubMed: 35989242
DOI: 10.1053/j.jvca.2022.06.033 -
The Journal of Thoracic and... Aug 2023
Topics: Humans; Child; Aortic Valve; Cardiac Surgical Procedures; Aortic Valve Insufficiency; Treatment Outcome; Cardiac Valve Annuloplasty
PubMed: 36351860
DOI: 10.1016/j.jtcvs.2022.10.019