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{{Infobox disease
| Name            = Bicuspid aortic valve
| Image          =
| Caption        =
| DiseasesDB      = 1392
| ICD10          =
| ICD9            = {{ICD9|746.4}}
| ICDO            =
| OMIM            = 109730
| MedlinePlus    = 007325
| eMedicineSubj  = ped
| eMedicineTopic  = 2486
| MeshID          =
}}
A '''bicuspid aortic valve''' (BAV) is most commonly a congenital condition of the [[aortic valve]] where two of the aortic valvular leaflets fuse during development resulting in a valve that is bicuspid instead of the normal tricuspid configuration. Normally the only cardiac valve that is bicuspid is the [[mitral valve]] (bicuspid valve) which is situated between the [[left atrium]] and [[left ventricle]]. Cardiac valves play a crucial role in ensuring the unidirectional flow of blood from the atrium to the ventricles, or the ventricle to the aorta or pulmonary trunk.
 
==Incidence/prevalence==
[[File:Heart bicuspid aortic valve.svg|thumb|500px|Heart bicuspid aortic valve anatomy.]]
Bicuspid aortic valves are the most common cardiac valvular anomaly, occurring in 1&ndash;2% of the general population. It is twice as common in males as in females.<ref name="pmid18799444">{{cite journal |author=Tzemos N |title=Outcomes in adults with bicuspid aortic valves |journal=JAMA |volume=300 |issue=11 |pages=1317–1325 |date=September 2008 |pmid=18799444 |doi=10.1001/jama.300.11.1317 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=18799444 |author-separator=, |author2=Therrien J |author3=Yip J |display-authors=3 |last4=Thanassoulis |first4=G. |last5=Tremblay |first5=S. |last6=Jamorski |first6=M. T. |last7=Webb |first7=G. D. |last8=Siu |first8=S. C.}}</ref>
 
Bicuspid aortic valve is an inheritable condition, with a demonstrated association with [[Notch 1]].<ref name="pmid16025100">{{cite journal |author=Garg V |title=Mutations in NOTCH1 cause aortic valve disease |journal=Nature |volume=437 |issue=7056 |pages=270–274 |year=2005 |pmid=16025100 |doi=10.1038/nature03940 |author-separator=, |author2=Muth AN |author3=Ransom JF |display-authors=3 |last4=Schluterman |first4=Marie K. |last5=Barnes |first5=Robert |last6=King |first6=Isabelle N. |last7=Grossfeld |first7=Paul D. |last8=Srivastava |first8=Deepak}}</ref> Its [[heritability]] (<math>h^2</math>) is as high as 89%.<ref name=inheritability>{{cite journal|last=Cripe|first=Linda|coauthors=Gregor Andelfinger, Lisa J. Martin, Kerry Shooner, D. Woodrow Benson|title=Bicuspid aortic valve is heritable|journal=J Am Coll Cardiol.|date=July 2004|year=2004|volume=44|issue=1|pages=138–143|doi=10.1016|url=http://content.onlinejacc.org/article.aspx?articleid=1135734|accessdate=11 August 2013}}</ref>  Both familial clustering and isolated valve defects have been documented. The incidence of bicuspid aortic valve can be as high as 10% in families affected with the valve problem. Recent studies suggest that BAV is an autosomal dominant condition with incomplete penetrance. Other congenital heart defects are associated with bicuspid aortic valve at various frequencies, including [[coarctation of the aorta]].<ref>{{cite book|last=Chhabra|first=Anikar|title=Pathology Recall|year=2002|publisher=LWW}}</ref>
 
==Classification==
Bicuspid aortic valves may assume three different types of configuration:<ref>{{cite book|last=Kumme|first=anja|title=Klassifikation bikuspider Aortenklappen|year=2007}}</ref>
# "Real" bicuspid valves with two symmetric leaflets
# A tricuspid architecture with a fusion of two leaflets
 
==Presentation==
In many cases, a bicuspid aortic valve will cause no problems.<ref>{{cite web |url=http://www.americanheart.org/presenter.jhtml?identifier=991 |title=Ask the Pediatric Cardiologist - Bicuspid Aortic Valve |accessdate=2007-08-08 |format= |work=| archiveurl= http://web.archive.org/web/20070926215735/http://www.americanheart.org/presenter.jhtml?identifier=991| archivedate= 26 September 2007 <!--DASHBot-->| deadurl= no}}</ref> However BAV may become calcified later in life, which may lead to varying degrees of severity of [[aortic stenosis]] that will manifest as [[heart murmur|murmur]]s. If the leaflets do not close correctly, [[Aortic insufficiency|aortic regurgitation]] can occur. If these become severe enough, they may require heart surgery. People with BAV may become tired more easily than those with normal valvular function and have difficulty maintaining stamina for cardio-intensive activities-due to poor heart performance. The heart is put under more stress in order to either pump more blood through a stenotic valve or attempt to circulate regurgitation blood through a leaking valve.
 
==Diagnosis, treatment, and prognosis==
[[File:Heart bicuspid aortic lpla.svg|thumb|300px|Heart bicuspid aortic valve diagram]]
The condition can be associated with a [[heart murmur]] located at the right second intercostal space. Often there will be differences in blood pressures between upper and lower extremities. The diagnosis can be assisted with [[echocardiography]] (EchoCG) or [[magnetic resonance imaging]] (MRI).
 
Most patients with bicuspid aortic valve whose valve becomes dysfunctional will need careful follow-up and potentially valve replacement at some point in life. Regular EchoCG and MRI may be performed. For diagnosed patients, genetic testing is done to allow for future offspring with the disease to be monitored and treated early in life.
 
Patients with bicuspid aortic valve should be followed by a cardiologist or cardiac surgeon with specific interest in this valve pathology.
 
If the valve is normally functioning or minimally dysfunctional, average lifespan is similar to that of those without the anomaly.<ref name="pmid18506017">{{cite journal |author=Michelena HI |title=Natural history of asymptomatic patients with normally functioning or minimally dysfunctional bicuspid aortic valve in the community |journal=Circulation |volume=117 |issue=21 |pages=2776–2784 |date=May 2008 |pmid=18506017 |doi=10.1161/CIRCULATIONAHA.107.740878 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=18506017 |pmc=2878133 |author-separator=, |author2=Desjardins VA |author3=Avierinos JF |display-authors=3 |last4=Russo |first4=A. |last5=Nkomo |first5=V. T. |last6=Sundt |first6=T. M. |last7=Pellikka |first7=P. A. |last8=Tajik |first8=A. J. |last9=Enriquez-Sarano |first9=M.}}</ref>
 
==Aorta complications==
 
One of the most notable associations with BAV is the tendency for these patients to present with ascending aortic aneurysmal lesions. 
The extracellular matrix of the aorta in patients with BAV shows marked deviations from that of the normal tricuspid aortic valve.
It is currently believed that an increase in the ratio of MMP2 (Matrix Metalloproteinases 2) to TIMP1 (Tissue Inhibitor Metalloproteinases 1) may be responsible for the abnormal degradation of the valve matrix and therefore lead to aortic dissection and aneurysm. However, other studies have also shown MMP9 involvement with no differences in TIMP expression. The size of the proximal aorta should be evaluated carefully during the work-up. The initial diameter of the aorta should be noted and annual evaluation with [[CT scan]], or [[MRI]] to avoid ionizing radiation, should be recommended to the patient; the examination should be conducted more frequently if a change in aortic diameter is seen. From this monitoring, the type of surgery that should be offered to the patient can be determined based on the change in size of the aorta.
 
Co-arctation of the aorta (a congenital narrowing in the region of the ductus arteriosus) has also been associated with BAV.<ref>{{cite journal|last=Rison|first=SC|coauthors=Locke, TP; Rosenthal, E; Gandhi, S|title=A man with hypertension and two murmurs.|journal=BMJ (Clinical research ed.)|date=Feb 15, 2012|volume=344|pages=e956|pmid=22337753}}</ref>
 
==References==
{{reflist|2}}
 
==External links==
* [http://bicuspidfoundation.com/ Bicuspid Aortic Foundation Homepage]
* [http://www.csmc.edu/3893.html Cedars Sinai Heart Center - Bicuspid Aortic Disease]
* [http://www.bicuspidaorticvalve.org/ Bicuspid Aortic Valve Discussion Board]
 
{{Congenital malformations and deformations of circulatory system}}
 
{{DEFAULTSORT:Bicuspid Aortic Valve}}
[[Category:Diseases of the aorta]]
[[Category:Congenital heart disease]]

Revision as of 20:19, 26 January 2014

31 yr old Master Fisher Kull from Griffin, has pastimes for example beach, property developers new condos in singapore singapore and fitness. Was lately paying a visit to Macquarie Island. A bicuspid aortic valve (BAV) is most commonly a congenital condition of the aortic valve where two of the aortic valvular leaflets fuse during development resulting in a valve that is bicuspid instead of the normal tricuspid configuration. Normally the only cardiac valve that is bicuspid is the mitral valve (bicuspid valve) which is situated between the left atrium and left ventricle. Cardiac valves play a crucial role in ensuring the unidirectional flow of blood from the atrium to the ventricles, or the ventricle to the aorta or pulmonary trunk.

Incidence/prevalence

Heart bicuspid aortic valve anatomy.

Bicuspid aortic valves are the most common cardiac valvular anomaly, occurring in 1–2% of the general population. It is twice as common in males as in females.[1]

Bicuspid aortic valve is an inheritable condition, with a demonstrated association with Notch 1.[2] Its heritability () is as high as 89%.[3] Both familial clustering and isolated valve defects have been documented. The incidence of bicuspid aortic valve can be as high as 10% in families affected with the valve problem. Recent studies suggest that BAV is an autosomal dominant condition with incomplete penetrance. Other congenital heart defects are associated with bicuspid aortic valve at various frequencies, including coarctation of the aorta.[4]

Classification

Bicuspid aortic valves may assume three different types of configuration:[5]

  1. "Real" bicuspid valves with two symmetric leaflets
  2. A tricuspid architecture with a fusion of two leaflets

Presentation

In many cases, a bicuspid aortic valve will cause no problems.[6] However BAV may become calcified later in life, which may lead to varying degrees of severity of aortic stenosis that will manifest as murmurs. If the leaflets do not close correctly, aortic regurgitation can occur. If these become severe enough, they may require heart surgery. People with BAV may become tired more easily than those with normal valvular function and have difficulty maintaining stamina for cardio-intensive activities-due to poor heart performance. The heart is put under more stress in order to either pump more blood through a stenotic valve or attempt to circulate regurgitation blood through a leaking valve.

Diagnosis, treatment, and prognosis

Heart bicuspid aortic valve diagram

The condition can be associated with a heart murmur located at the right second intercostal space. Often there will be differences in blood pressures between upper and lower extremities. The diagnosis can be assisted with echocardiography (EchoCG) or magnetic resonance imaging (MRI).

Most patients with bicuspid aortic valve whose valve becomes dysfunctional will need careful follow-up and potentially valve replacement at some point in life. Regular EchoCG and MRI may be performed. For diagnosed patients, genetic testing is done to allow for future offspring with the disease to be monitored and treated early in life.

Patients with bicuspid aortic valve should be followed by a cardiologist or cardiac surgeon with specific interest in this valve pathology.

If the valve is normally functioning or minimally dysfunctional, average lifespan is similar to that of those without the anomaly.[7]

Aorta complications

One of the most notable associations with BAV is the tendency for these patients to present with ascending aortic aneurysmal lesions. The extracellular matrix of the aorta in patients with BAV shows marked deviations from that of the normal tricuspid aortic valve. It is currently believed that an increase in the ratio of MMP2 (Matrix Metalloproteinases 2) to TIMP1 (Tissue Inhibitor Metalloproteinases 1) may be responsible for the abnormal degradation of the valve matrix and therefore lead to aortic dissection and aneurysm. However, other studies have also shown MMP9 involvement with no differences in TIMP expression. The size of the proximal aorta should be evaluated carefully during the work-up. The initial diameter of the aorta should be noted and annual evaluation with CT scan, or MRI to avoid ionizing radiation, should be recommended to the patient; the examination should be conducted more frequently if a change in aortic diameter is seen. From this monitoring, the type of surgery that should be offered to the patient can be determined based on the change in size of the aorta.

Co-arctation of the aorta (a congenital narrowing in the region of the ductus arteriosus) has also been associated with BAV.[8]

References

43 year old Petroleum Engineer Harry from Deep River, usually spends time with hobbies and interests like renting movies, property developers in singapore new condominium and vehicle racing. Constantly enjoys going to destinations like Camino Real de Tierra Adentro.

External links

Template:Congenital malformations and deformations of circulatory system

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    A vendor's stamp duty has been launched on industrial property for the primary time, at rates ranging from 5 per cent to 15 per cent. The Authorities might be trying to reassure the market that they aren't in opposition to foreigners and PRs investing in Singapore's property market. They imposed these measures because of extenuating components available in the market." The sale of new dual-key EC models will even be restricted to multi-generational households only. The models have two separate entrances, permitting grandparents, for example, to dwell separately. The vendor's stamp obligation takes effect right this moment and applies to industrial property and plots which might be offered inside three years of the date of buy. JLL named Best Performing Property Brand for second year running

    The data offered is for normal info purposes only and isn't supposed to be personalised investment or monetary advice. Motley Fool Singapore contributor Stanley Lim would not personal shares in any corporations talked about. Singapore private home costs increased by 1.eight% within the fourth quarter of 2012, up from 0.6% within the earlier quarter. Resale prices of government-built HDB residences which are usually bought by Singaporeans, elevated by 2.5%, quarter on quarter, the quickest acquire in five quarters. And industrial property, prices are actually double the levels of three years ago. No withholding tax in the event you sell your property. All your local information regarding vital HDB policies, condominium launches, land growth, commercial property and more

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  3. One of the biggest reasons investing in a Singapore new launch is an effective things is as a result of it is doable to be lent massive quantities of money at very low interest rates that you should utilize to purchase it. Then, if property values continue to go up, then you'll get a really high return on funding (ROI). Simply make sure you purchase one of the higher properties, reminiscent of the ones at Fernvale the Riverbank or any Singapore landed property Get Earnings by means of Renting

    In its statement, the singapore property listing - website link, government claimed that the majority citizens buying their first residence won't be hurt by the new measures. Some concessions can even be prolonged to chose teams of consumers, similar to married couples with a minimum of one Singaporean partner who are purchasing their second property so long as they intend to promote their first residential property. Lower the LTV limit on housing loans granted by monetary establishments regulated by MAS from 70% to 60% for property purchasers who are individuals with a number of outstanding housing loans on the time of the brand new housing purchase. Singapore Property Measures - 30 August 2010 The most popular seek for the number of bedrooms in Singapore is 4, followed by 2 and three. Lush Acres EC @ Sengkang

    Discover out more about real estate funding in the area, together with info on international funding incentives and property possession. Many Singaporeans have been investing in property across the causeway in recent years, attracted by comparatively low prices. However, those who need to exit their investments quickly are likely to face significant challenges when trying to sell their property – and could finally be stuck with a property they can't sell. Career improvement programmes, in-house valuation, auctions and administrative help, venture advertising and marketing, skilled talks and traisning are continuously planned for the sales associates to help them obtain better outcomes for his or her shoppers while at Knight Frank Singapore. No change Present Rules

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    A vendor's stamp duty has been launched on industrial property for the primary time, at rates ranging from 5 per cent to 15 per cent. The Authorities might be trying to reassure the market that they aren't in opposition to foreigners and PRs investing in Singapore's property market. They imposed these measures because of extenuating components available in the market." The sale of new dual-key EC models will even be restricted to multi-generational households only. The models have two separate entrances, permitting grandparents, for example, to dwell separately. The vendor's stamp obligation takes effect right this moment and applies to industrial property and plots which might be offered inside three years of the date of buy. JLL named Best Performing Property Brand for second year running

    The data offered is for normal info purposes only and isn't supposed to be personalised investment or monetary advice. Motley Fool Singapore contributor Stanley Lim would not personal shares in any corporations talked about. Singapore private home costs increased by 1.eight% within the fourth quarter of 2012, up from 0.6% within the earlier quarter. Resale prices of government-built HDB residences which are usually bought by Singaporeans, elevated by 2.5%, quarter on quarter, the quickest acquire in five quarters. And industrial property, prices are actually double the levels of three years ago. No withholding tax in the event you sell your property. All your local information regarding vital HDB policies, condominium launches, land growth, commercial property and more

    There are various methods to go about discovering the precise property. Some local newspapers (together with the Straits Instances ) have categorised property sections and many local property brokers have websites. Now there are some specifics to consider when buying a 'new launch' rental. Intended use of the unit Every sale begins with 10 p.c low cost for finish of season sale; changes to 20 % discount storewide; follows by additional reduction of fiftyand ends with last discount of 70 % or extra. Typically there is even a warehouse sale or transferring out sale with huge mark-down of costs for stock clearance. Deborah Regulation from Expat Realtor shares her property market update, plus prime rental residences and houses at the moment available to lease Esparina EC @ Sengkang
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    In its statement, the singapore property listing - website link, government claimed that the majority citizens buying their first residence won't be hurt by the new measures. Some concessions can even be prolonged to chose teams of consumers, similar to married couples with a minimum of one Singaporean partner who are purchasing their second property so long as they intend to promote their first residential property. Lower the LTV limit on housing loans granted by monetary establishments regulated by MAS from 70% to 60% for property purchasers who are individuals with a number of outstanding housing loans on the time of the brand new housing purchase. Singapore Property Measures - 30 August 2010 The most popular seek for the number of bedrooms in Singapore is 4, followed by 2 and three. Lush Acres EC @ Sengkang

    Discover out more about real estate funding in the area, together with info on international funding incentives and property possession. Many Singaporeans have been investing in property across the causeway in recent years, attracted by comparatively low prices. However, those who need to exit their investments quickly are likely to face significant challenges when trying to sell their property – and could finally be stuck with a property they can't sell. Career improvement programmes, in-house valuation, auctions and administrative help, venture advertising and marketing, skilled talks and traisning are continuously planned for the sales associates to help them obtain better outcomes for his or her shoppers while at Knight Frank Singapore. No change Present Rules

    Extending the tax exemption would help. The exemption, which may be as a lot as $2 million per family, covers individuals who negotiate a principal reduction on their existing mortgage, sell their house short (i.e., for lower than the excellent loans), or take part in a foreclosure course of. An extension of theexemption would seem like a common-sense means to assist stabilize the housing market, but the political turmoil around the fiscal-cliff negotiations means widespread sense could not win out. Home Minority Chief Nancy Pelosi (D-Calif.) believes that the mortgage relief provision will be on the table during the grand-cut price talks, in response to communications director Nadeam Elshami. Buying or promoting of blue mild bulbs is unlawful.

    A vendor's stamp duty has been launched on industrial property for the primary time, at rates ranging from 5 per cent to 15 per cent. The Authorities might be trying to reassure the market that they aren't in opposition to foreigners and PRs investing in Singapore's property market. They imposed these measures because of extenuating components available in the market." The sale of new dual-key EC models will even be restricted to multi-generational households only. The models have two separate entrances, permitting grandparents, for example, to dwell separately. The vendor's stamp obligation takes effect right this moment and applies to industrial property and plots which might be offered inside three years of the date of buy. JLL named Best Performing Property Brand for second year running

    The data offered is for normal info purposes only and isn't supposed to be personalised investment or monetary advice. Motley Fool Singapore contributor Stanley Lim would not personal shares in any corporations talked about. Singapore private home costs increased by 1.eight% within the fourth quarter of 2012, up from 0.6% within the earlier quarter. Resale prices of government-built HDB residences which are usually bought by Singaporeans, elevated by 2.5%, quarter on quarter, the quickest acquire in five quarters. And industrial property, prices are actually double the levels of three years ago. No withholding tax in the event you sell your property. All your local information regarding vital HDB policies, condominium launches, land growth, commercial property and more

    There are various methods to go about discovering the precise property. Some local newspapers (together with the Straits Instances ) have categorised property sections and many local property brokers have websites. Now there are some specifics to consider when buying a 'new launch' rental. Intended use of the unit Every sale begins with 10 p.c low cost for finish of season sale; changes to 20 % discount storewide; follows by additional reduction of fiftyand ends with last discount of 70 % or extra. Typically there is even a warehouse sale or transferring out sale with huge mark-down of costs for stock clearance. Deborah Regulation from Expat Realtor shares her property market update, plus prime rental residences and houses at the moment available to lease Esparina EC @ Sengkang
  8. One of the biggest reasons investing in a Singapore new launch is an effective things is as a result of it is doable to be lent massive quantities of money at very low interest rates that you should utilize to purchase it. Then, if property values continue to go up, then you'll get a really high return on funding (ROI). Simply make sure you purchase one of the higher properties, reminiscent of the ones at Fernvale the Riverbank or any Singapore landed property Get Earnings by means of Renting

    In its statement, the singapore property listing - website link, government claimed that the majority citizens buying their first residence won't be hurt by the new measures. Some concessions can even be prolonged to chose teams of consumers, similar to married couples with a minimum of one Singaporean partner who are purchasing their second property so long as they intend to promote their first residential property. Lower the LTV limit on housing loans granted by monetary establishments regulated by MAS from 70% to 60% for property purchasers who are individuals with a number of outstanding housing loans on the time of the brand new housing purchase. Singapore Property Measures - 30 August 2010 The most popular seek for the number of bedrooms in Singapore is 4, followed by 2 and three. Lush Acres EC @ Sengkang

    Discover out more about real estate funding in the area, together with info on international funding incentives and property possession. Many Singaporeans have been investing in property across the causeway in recent years, attracted by comparatively low prices. However, those who need to exit their investments quickly are likely to face significant challenges when trying to sell their property – and could finally be stuck with a property they can't sell. Career improvement programmes, in-house valuation, auctions and administrative help, venture advertising and marketing, skilled talks and traisning are continuously planned for the sales associates to help them obtain better outcomes for his or her shoppers while at Knight Frank Singapore. No change Present Rules

    Extending the tax exemption would help. The exemption, which may be as a lot as $2 million per family, covers individuals who negotiate a principal reduction on their existing mortgage, sell their house short (i.e., for lower than the excellent loans), or take part in a foreclosure course of. An extension of theexemption would seem like a common-sense means to assist stabilize the housing market, but the political turmoil around the fiscal-cliff negotiations means widespread sense could not win out. Home Minority Chief Nancy Pelosi (D-Calif.) believes that the mortgage relief provision will be on the table during the grand-cut price talks, in response to communications director Nadeam Elshami. Buying or promoting of blue mild bulbs is unlawful.

    A vendor's stamp duty has been launched on industrial property for the primary time, at rates ranging from 5 per cent to 15 per cent. The Authorities might be trying to reassure the market that they aren't in opposition to foreigners and PRs investing in Singapore's property market. They imposed these measures because of extenuating components available in the market." The sale of new dual-key EC models will even be restricted to multi-generational households only. The models have two separate entrances, permitting grandparents, for example, to dwell separately. The vendor's stamp obligation takes effect right this moment and applies to industrial property and plots which might be offered inside three years of the date of buy. JLL named Best Performing Property Brand for second year running

    The data offered is for normal info purposes only and isn't supposed to be personalised investment or monetary advice. Motley Fool Singapore contributor Stanley Lim would not personal shares in any corporations talked about. Singapore private home costs increased by 1.eight% within the fourth quarter of 2012, up from 0.6% within the earlier quarter. Resale prices of government-built HDB residences which are usually bought by Singaporeans, elevated by 2.5%, quarter on quarter, the quickest acquire in five quarters. And industrial property, prices are actually double the levels of three years ago. No withholding tax in the event you sell your property. All your local information regarding vital HDB policies, condominium launches, land growth, commercial property and more

    There are various methods to go about discovering the precise property. Some local newspapers (together with the Straits Instances ) have categorised property sections and many local property brokers have websites. Now there are some specifics to consider when buying a 'new launch' rental. Intended use of the unit Every sale begins with 10 p.c low cost for finish of season sale; changes to 20 % discount storewide; follows by additional reduction of fiftyand ends with last discount of 70 % or extra. Typically there is even a warehouse sale or transferring out sale with huge mark-down of costs for stock clearance. Deborah Regulation from Expat Realtor shares her property market update, plus prime rental residences and houses at the moment available to lease Esparina EC @ Sengkang