Biomechanical indicators of bicuspid aortic valve dysfunction

摘要：二叶式主动脉瓣（BAV）是最常见的先天性心脏病， 异常，影响约1.4%的人群，男性比例约为2：1 优势由于筛查的广泛可用性和常规使用， 超声心动图，识别无症状的年轻BAV患者， 变得越来越普遍。据估计，30%-50%的BAV患者将 在他们的生活中的某个时候需要手术干预（1）。手术是最常见的 钙化性主动脉瓣疾病（CAVD）所需，导致症状性主动脉 狭窄（AS）;主动脉瓣关闭不全（AI）、升主动脉瓣 动脉瘤和夹层50岁以下的主动脉瓣置换术（AVR）患者 老年人有AS，几乎所有人都有BAV。事实上，直到70岁的BAV患者 因主动脉瓣狭窄行主动脉瓣置换术的患者多于三尖瓣主动脉瓣（TAV）患者。71-80之间 在有症状的AS中，BAV和TAV的发生率大致相同 患者，直到80岁以上TAV患者才占优势（2）。而 BAV患者AS的发生可能与多种因素有关， 与主动脉夹层相关，BAV的存在始终是一个例外， 过早AS的危险因素。然而，尽管有这种强烈的临床关联， 目前无法评估哪些BAV患者的风险最高， 发展为AS，预防BAV患者风险分层的合理依据。我们因此 假设敏感的、临床上可导出的功能指数可以从 患者特定的动态BAV解剖结构，当与基于人群的 瓣叶特性，将产生临床相关的患者特异性策略，用于识别 BAV患者将来发生症状性AS的风险较高。 叙述：二叶式主动脉瓣（BAV）是最常见的先天性心脏病 异常由于筛查的广泛可用性和常规使用， 超声心动图，临床方法的发展，用于识别 无症状的BAV年轻患者现在是现实的。因此，我们计划开发 敏感的、临床可导出的功能指标，将产生临床相关的患者- 确定高危BAV患者的具体策略。

Summary: The bicuspid aortic valve (BAV) is the most common cardiac congenital anomaly and affects ~1.4% of the population, with an approximate 2:1 male predominance. Due to the widespread availability and routine use of screening echocardiography, the identification of asymptomatic young patients with BAV has become increasingly common. It has been estimated that 30%-50% of BAV patients will require surgical intervention at some point in their life (1). Surgery is most commonly required for calcific aortic valve disease (CAVD) that results in symptomatic aortic stenosis (AS); less commonly required for aortic insufficiency (AI), ascending aortic aneurysm, and dissection. In aortic valve replacement (AVR) patients under 50 years old having AS, virtually all of them have BAV. In fact, until the age of 70 BAV patients outnumber those with tricuspid aortic valve (TAV) having AVR for AS. Between 71-80 years of age BAV and TAV occur in approximately equal numbers in symptomatic AS patients, and not until over the age of 80 do TAV patients predominate (2). While multiple factors are likely involved in the prevalence of AS in BAV patients and its relation to aortic dissection, the presence of a BAV is consistently an exceptionally strong risk factor for premature AS. Yet, in spite of this strong clinical association it is not currently possible to assess which patients with BAV are at highest risk for developing AS, preventing a rational basis for BAV patient risk stratification. We thus hypothesize that sensitive, clinically derivable functional indices can be obtained from patient-specific dynamic BAV anatomy that, when combined with population-based leaflet properties, will yield clinically relevant patient-specific strategies for identifying BAV patients at high risk for developing symptomatic AS in the future. Narrative: The bicuspid aortic valve (BAV) is the most common cardiac congenital anomaly. Due to the widespread availability and routine use of screening echocardiography, development of clinical methods for the identification of asymptomatic young patients with BAV is now realistic. We thus plan to develop sensitive, clinically derivable functional indices that will yield clinically relevant patient- specific strategies for identifying BAV patients at high risk.