Biküspid Aortik Kapak
Özet
Bu bölümde biküspit aort kapak epidemiyolojisi, genetik hastalıklarla ilişkisi ve biküspit aort kapak tiplerine değinilmiştir. Ek olarak biküspit aort kapak ile valvulopati, aortapati, infektif endokardit ve gebelik gibi durumlarla bağlantı da irdelenmiştir. Görüntüleme ve tedavi yöntemleri ile ilgili de güncel kılavuzlar eşliğinde bilgiler eklenmiştir.
Referanslar
Hoffman JIE, Kaplan S. The incidence of congenital heart disease. Journal off the American College of Cardiology. 2002;39:1890–900. doi: 10.1016/s0735-1097(02)01886-7.
Tutar E, Ekici F, Atalay S, Nacar N. The prevalence of bicuspid aortic valve in newborns by echocardiographic screening. American Heart Journal. 2005;150:513-515. doi: 10.1016/j.ahj.2004.10.036.
Benson DW. The genetics of congenital heart disease: a point in the revolution. Cardiology Clinics. 2002; 20(3):385–394. doi: 10.1016/s0733-8651(02)00009-7.
Emanuel R, Withers R, O’Brien K, et al. Congenitally bicuspid aortic valves. Clinicogenetic study of 41 families. British Heart Journal. 1978; 40(12):1402–1407. doi: 10.1136/hrt.40.12.1402.
V. Garg, A.N. Muth, J.F. Ransom, et al. Mutations in NOTCH1 cause aortic valve disease. Nature. 437 (2005) 270–274. doi: 10.1038/nature03940.Epub 2005 jul 2017.
G. Pepe, S. Nistri, B. Giusti, et al. Identification of fibrillin 1 gene mutations in patients with bicuspid aortic valve (BAV) without Marfan syndrome. BMC Medical. Genetics. 15 (2014) 23. doi: 10.1186/1471-2350-15-23.
Biner S, Rafi que AM, Ray I, et al. Aortopathy is prevalent in relatives of bicuspid aortic valve patients. The Journal American College Cardiology. 2009; 53(24):2288–2295. doi:10.1016/j.jacc.2009.03.027.
Sert A, Aslan E, Sap F, et al. Evaluation of Our Patients Diagnosed with Bicuspid Aortic Valve. Pediatric Heart Journal. 2015;2:117-23.
Duran A, Frescura C, Sans-Coma V, et al. Bicuspid aortic valves in hearts with other congenital heart disease. The Journal of Heart Valve Disease.1995;4:581-90.
Hinton RB, Martin LJ, Tabangin ME. Hypoplastic left heart syndrome is heritable. Journal of the American College of Cardiology. 2007;50:1590-5. doi: 10.1016/j.jacc.2007.07.021.
Roos-Hesselink J, Schölzel B, Heijdra R, et al. Aortic valve and aortic arch pathology after coarctation repair. Heart. 2003;89:1074-7. doi: 10.1136/heart.89.91074.
Michalowska IM, Hryniewiecki T, Kwiatek P, et al. Coronary artery variants and anomalies in patients with bicuspid aortic valve. Journal Thoracic Imaging. 2016; 31(3):156–162. doi:10.1097/RTI.0000000000000205.
Michelena HI. International consensus statement on nomenclature and classification of the congenital bicuspid aortic valve and its aortopathy, for clinical, surgical, interventional and research purposes. The Annals of Thoracic Surgery. 2021; doi: 10.1016/j.athoracsur.2020.08.119
Michelena HI, Della Corte A, Evangelista A, et al. Speaking a common language: introduction to a standard terminology for the bicuspid aortic valve and its aortopathy. Progress in Cardiovascular Disease. 2020;63:419-424. doi: 10.1016/j.pcad.2020.06.006.
Sabet HY, Edwards WD, Tazelaar HD, et al. Congenitally bicuspid aortic valves: a surgical pathology study of 542 cases (1991 through 1996) and a literature review of 2,715 additional cases. Mayo Clinic Proceedings. 1999;74: 14-26. doi: 10.4065/74.1.14.
Sperling JS, Lubat E. Forme fruste or ‘Incomplete’ bicuspid aortic valves with very small raphes: the prevalence of bicuspid valve and its significance may be underestimated. International Journal of Cardiology. 2015;184:1-5. doi: 10.1016/j.ijcard.2015.02.013.
Guala A, Rodriguez-Palomares J, Galian-Gay L, et al. Partial aortic valve leaflet fusion is related to deleterious alteration of proximal aorta hemodynamics. Circulation. 2019;139:2707-2709. doi: 10.1161/CIRCULATIONAHA.119.039693.
Michelena HI, Yang LT, Enriquez-Sarano M, Pochettino A. The elusive ‘forme fruste’ bicuspid aortic valve: 3D transoesophageal echocardiography to the rescue. Europan Heart Journal Cardiovascular Imaging. 2020;21, 1169–1169. doi: 10.1093/ehjci/jeaa094.
Aydin A, Desai N, Bernhardt AM, et al. Ascending aortic aneurysm and aortic valve dysfunction in bicuspid aortic valve disease. Internaional Journal of Cardiology. 2013;164:301-305. doi: 10.1016/j.ijcard.2011.07.018.
Pachulski RT, Chan K-L. Progression of aortic valve dysfunction in 51 adult patients with congenital bicuspid aortic valve: assessment and follow up by Doppler echocardiography. British Heart journal. 1993;69:237-40. doi: 10.1136/hrt.69.3.237.
Braverman AC, Guven H, Beardslee MA, et al. The bicuspid aortic valve. Current Problems Cardiology. 2005;30:470-522. doi: 10.1016/j.cpccardiol.2005.06.002.
Wagner H, Ellison R, Keane J, et al. Clinical course in aortic stenosis. Circulation. 1977;56:I47-56. pmid: 872345.
Michelena H, Desjardins V, Avierinos J, et al. Natural History of Patients with Asymptomatic, Normally Functioning or Minimally Dysfunctional Bicuspid Aortic Valve in the Community. Curcilation. 2008; 117(21): 2776-84. doi: 10.1161/CIRCULATİONAHA.107.740878.
Kong WK, Regeer MV, Ng AC, et al. Sex differences in phenotypes of bicuspid aortic valve and aortopathy: insights from a large multicenter, international registry. Circulation Cardiovascular Imaging. 2017;10. doi: 10.1161/CIRCIMAGING.116.005155.
Kong WK, Delgado V, Poh KK, et al. Prognostic implications of raphe in bicuspid aortic valve anatomy. The Journal of the American Medical Association cardiology. 2017;2:285-292. doi: 10.1001/jamacardio. 2016.5228.
Masri A, Kalahasti V, Alkharabsheh S, et al. Characteristics and long-term outcomes of contemporary patients with bicuspid aortic valves. The Journal of Thoracic Cardiovascular Surgery. 2016;151:1650-1659. (e1651). doi: 10.1016/j.jtcvs.2015.12.019.
S.C. Siu, C.K. Silversides, Bicuspid aortic valve disease, Journal of the American College.Cardiology. 55 (2010) 2789–2800. doi: 10.1016/j.jacc.2009.12.068.
Morgan-Hughes GJ, Roobottom CA, Owens PE, et al. Dilatation of the aorta in pure, severe, bicuspid aortic valve stenosis. American Heart Journal. 2004;147:736-40. doi: 10.1016/j.ahj.2003.10.044.
Masri A, Svensson LG, Griffin BP, et al. Contemporary natural history of bicuspid aortic valve disease: a systematic review. Heart. 2017;103:1323–30. doi: 10.1136/heartjnl-2016- 309916
Jost CHA, Schaff HV, Connolly HM, et al. Spectrum of reoperations after repair of aortic coarctation: importance of an individualized approach because of coexistent cardiovascular disease. Mayo Clinic Proceedings. 2002: Elsevier. doi: 10.4065/77.7.646.
Erbel R, Aboyans V, Boileau C, et al. 2014 esc guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The task force for the diagnosis and treatment of aortic diseases of the european society of cardiology (esc). European Heart Journal. 2014;35:2873-2926. doi: 10.1093/eurheartj/ehu281.
Ward C. Clinical significance of the bicuspid aortic valve. Heart. 2000;83:81-5. doi: 10.1136/heart.83.1.81.
E. Girdauskas, M. Rouman, K. Disha, A, et al. Borger, et al. Aortic dissection after previous aortic valve replacement for bicuspid aortic valve disease, Journal of the American College of Cardiology. 66 (2015) 1409–1411. doi: 10.1016/j.jacc.2015.07.022.
W.I. Schievink, S.S. Raissi, M.M. Maya, et al. Screening for intracranial aneurysms in patients with bicuspid aortic valve. Neurology. 74 (2010) 1430–1433. doi: 10.1212/WNL.0b013e3181dc1acf.
C. Egbe, R. Padang, R.D. Brown, et al. Prevalence and predictors of intracranial aneurysms in patients with bicuspid aortic valve. Heart. 103 (2017) 1508–1514. doi: 10.1136/heartjnl-2016-311076.
Allen BD, Markl M, Barker AJ, et al. Infl uence of beta-blocker therapy on aortic blood flow in patients with bicuspid aortic valve. The International journal of Cardiovascular Imaging. 2016; 32(4):621–628. doi:10.1007/s10554-015-0819-3. doi: 10.1007/s10554-015-0819-3.
Ohnemus D, Oster ME, Gatlin S, et al. The effect of angiotensin-converting enzyme inhibitors on the rate of ascending aorta dilation in patients with bicuspid aortic valve. Congenital Heart Disease. 2015; 10(1):E1–E5. doi:10.1111/chd.12184
Helmut Baumgartner, Volkmar Falk, Jeroen J. Bax, et all. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. European heart journal. 2017 sep 21;38(36):2739-2791. doi: 10.1093/eurheartj/ehx391.
Michelena HI, Katan O, Suri RM,et al. Incidence of infective endocarditis in patients with bicuspid aortic valves in the community. Mayo Clinic Proceedings. 2016;91:122-123. doi: 10.1016/j.mayocp.2015.10.011.
Michelena HI, Prakash SK, Della Corte A, et al. Bicuspid aortic valve: identifying knowledge gaps and rising to the challenge from the international bicuspid aortic valve consortium (bavcon). Circulation. 2014;129:2691-2704. doi: 10.1161/CIRULATİONAHA.113.007851.
Oliver JM, Alonso-Gonzalez R, Gonzalez AE, et al. Risk of aortic root or ascending aorta complications in patients with bicuspid aortic valve with and without coarctation of the aorta. The American Journal of Cardiology. 2009;104:1001-6. doi: 10.1016/j.amjcard.2009.05.045
Yener N, Oktar GL, Erer D, et al. Bicuspid aortic valve. Annals of Thoracic Cardiovascular Surgery. 2002; 8(5):264–267. pmid:12472407.
Smok DA: Aortopathy in pregnancy. Seminars in Perinatology. 2014, 38:295-303. doi: 10.1053/j.semperi.2014.04.019
Thorne SA. Pregnancy in heart disease. Heart. 2004; 90(4):450–456. doi: 10.1136/hrt.2003.027888.
Immer FF, Bansi AG, Immer-Bansi AS, et al. Aortic dissection in pregnancy: analysis of risk factors and outcome. Annals of Thoracic Cardiovascular Surgery. 2003; 76(1):309–314. doi: 10.1016/s0003-4975(03)00169-3.
McKellar SH, MacDonald RJ, Michelena HI, et al. Frequency of cardiovascular events in women with a congenitally bicuspid aortic valve in a single community and effect of pregnancy on events. The American Journal of Cardiology. 2011;107:96–99. doi: 10.1016/j.amjcard.2010.08.061.
Shah SY, Higgins A, Desai MY. Bicuspid aortic valve: basics and beyond. Clevelad Clinic Journal of Medicine. 2018, 85(10)779-784. doi: 10.3949/ccjm.85a.17069.
Hiratzka L, Bakris G, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease. Circulation. 2010; 121(13):e266–e369. doi:10.1161/CIR.0b013e3181d4739e.
Koh TW. Diagnosis of bicuspid aortic valve: role of three-dimensional transesophageal echocardiography and multiplane review analysis. Echocardiography a Journal of Cardiovascular Imaging and Intervention. 2013;30:360–3. doi: 10.1111/echo.12068.
Kiefer TL, Wang A, Hughes GC, et al. Management of patients with bicuspid aortic valve disease. Current Treatmant Options in Cardiovascular Medicine. 2011; 13(6):489–505. doi:10.1007/s11936-011-0152-7.
Referanslar
Hoffman JIE, Kaplan S. The incidence of congenital heart disease. Journal off the American College of Cardiology. 2002;39:1890–900. doi: 10.1016/s0735-1097(02)01886-7.
Tutar E, Ekici F, Atalay S, Nacar N. The prevalence of bicuspid aortic valve in newborns by echocardiographic screening. American Heart Journal. 2005;150:513-515. doi: 10.1016/j.ahj.2004.10.036.
Benson DW. The genetics of congenital heart disease: a point in the revolution. Cardiology Clinics. 2002; 20(3):385–394. doi: 10.1016/s0733-8651(02)00009-7.
Emanuel R, Withers R, O’Brien K, et al. Congenitally bicuspid aortic valves. Clinicogenetic study of 41 families. British Heart Journal. 1978; 40(12):1402–1407. doi: 10.1136/hrt.40.12.1402.
V. Garg, A.N. Muth, J.F. Ransom, et al. Mutations in NOTCH1 cause aortic valve disease. Nature. 437 (2005) 270–274. doi: 10.1038/nature03940.Epub 2005 jul 2017.
G. Pepe, S. Nistri, B. Giusti, et al. Identification of fibrillin 1 gene mutations in patients with bicuspid aortic valve (BAV) without Marfan syndrome. BMC Medical. Genetics. 15 (2014) 23. doi: 10.1186/1471-2350-15-23.
Biner S, Rafi que AM, Ray I, et al. Aortopathy is prevalent in relatives of bicuspid aortic valve patients. The Journal American College Cardiology. 2009; 53(24):2288–2295. doi:10.1016/j.jacc.2009.03.027.
Sert A, Aslan E, Sap F, et al. Evaluation of Our Patients Diagnosed with Bicuspid Aortic Valve. Pediatric Heart Journal. 2015;2:117-23.
Duran A, Frescura C, Sans-Coma V, et al. Bicuspid aortic valves in hearts with other congenital heart disease. The Journal of Heart Valve Disease.1995;4:581-90.
Hinton RB, Martin LJ, Tabangin ME. Hypoplastic left heart syndrome is heritable. Journal of the American College of Cardiology. 2007;50:1590-5. doi: 10.1016/j.jacc.2007.07.021.
Roos-Hesselink J, Schölzel B, Heijdra R, et al. Aortic valve and aortic arch pathology after coarctation repair. Heart. 2003;89:1074-7. doi: 10.1136/heart.89.91074.
Michalowska IM, Hryniewiecki T, Kwiatek P, et al. Coronary artery variants and anomalies in patients with bicuspid aortic valve. Journal Thoracic Imaging. 2016; 31(3):156–162. doi:10.1097/RTI.0000000000000205.
Michelena HI. International consensus statement on nomenclature and classification of the congenital bicuspid aortic valve and its aortopathy, for clinical, surgical, interventional and research purposes. The Annals of Thoracic Surgery. 2021; doi: 10.1016/j.athoracsur.2020.08.119
Michelena HI, Della Corte A, Evangelista A, et al. Speaking a common language: introduction to a standard terminology for the bicuspid aortic valve and its aortopathy. Progress in Cardiovascular Disease. 2020;63:419-424. doi: 10.1016/j.pcad.2020.06.006.
Sabet HY, Edwards WD, Tazelaar HD, et al. Congenitally bicuspid aortic valves: a surgical pathology study of 542 cases (1991 through 1996) and a literature review of 2,715 additional cases. Mayo Clinic Proceedings. 1999;74: 14-26. doi: 10.4065/74.1.14.
Sperling JS, Lubat E. Forme fruste or ‘Incomplete’ bicuspid aortic valves with very small raphes: the prevalence of bicuspid valve and its significance may be underestimated. International Journal of Cardiology. 2015;184:1-5. doi: 10.1016/j.ijcard.2015.02.013.
Guala A, Rodriguez-Palomares J, Galian-Gay L, et al. Partial aortic valve leaflet fusion is related to deleterious alteration of proximal aorta hemodynamics. Circulation. 2019;139:2707-2709. doi: 10.1161/CIRCULATIONAHA.119.039693.
Michelena HI, Yang LT, Enriquez-Sarano M, Pochettino A. The elusive ‘forme fruste’ bicuspid aortic valve: 3D transoesophageal echocardiography to the rescue. Europan Heart Journal Cardiovascular Imaging. 2020;21, 1169–1169. doi: 10.1093/ehjci/jeaa094.
Aydin A, Desai N, Bernhardt AM, et al. Ascending aortic aneurysm and aortic valve dysfunction in bicuspid aortic valve disease. Internaional Journal of Cardiology. 2013;164:301-305. doi: 10.1016/j.ijcard.2011.07.018.
Pachulski RT, Chan K-L. Progression of aortic valve dysfunction in 51 adult patients with congenital bicuspid aortic valve: assessment and follow up by Doppler echocardiography. British Heart journal. 1993;69:237-40. doi: 10.1136/hrt.69.3.237.
Braverman AC, Guven H, Beardslee MA, et al. The bicuspid aortic valve. Current Problems Cardiology. 2005;30:470-522. doi: 10.1016/j.cpccardiol.2005.06.002.
Wagner H, Ellison R, Keane J, et al. Clinical course in aortic stenosis. Circulation. 1977;56:I47-56. pmid: 872345.
Michelena H, Desjardins V, Avierinos J, et al. Natural History of Patients with Asymptomatic, Normally Functioning or Minimally Dysfunctional Bicuspid Aortic Valve in the Community. Curcilation. 2008; 117(21): 2776-84. doi: 10.1161/CIRCULATİONAHA.107.740878.
Kong WK, Regeer MV, Ng AC, et al. Sex differences in phenotypes of bicuspid aortic valve and aortopathy: insights from a large multicenter, international registry. Circulation Cardiovascular Imaging. 2017;10. doi: 10.1161/CIRCIMAGING.116.005155.
Kong WK, Delgado V, Poh KK, et al. Prognostic implications of raphe in bicuspid aortic valve anatomy. The Journal of the American Medical Association cardiology. 2017;2:285-292. doi: 10.1001/jamacardio. 2016.5228.
Masri A, Kalahasti V, Alkharabsheh S, et al. Characteristics and long-term outcomes of contemporary patients with bicuspid aortic valves. The Journal of Thoracic Cardiovascular Surgery. 2016;151:1650-1659. (e1651). doi: 10.1016/j.jtcvs.2015.12.019.
S.C. Siu, C.K. Silversides, Bicuspid aortic valve disease, Journal of the American College.Cardiology. 55 (2010) 2789–2800. doi: 10.1016/j.jacc.2009.12.068.
Morgan-Hughes GJ, Roobottom CA, Owens PE, et al. Dilatation of the aorta in pure, severe, bicuspid aortic valve stenosis. American Heart Journal. 2004;147:736-40. doi: 10.1016/j.ahj.2003.10.044.
Masri A, Svensson LG, Griffin BP, et al. Contemporary natural history of bicuspid aortic valve disease: a systematic review. Heart. 2017;103:1323–30. doi: 10.1136/heartjnl-2016- 309916
Jost CHA, Schaff HV, Connolly HM, et al. Spectrum of reoperations after repair of aortic coarctation: importance of an individualized approach because of coexistent cardiovascular disease. Mayo Clinic Proceedings. 2002: Elsevier. doi: 10.4065/77.7.646.
Erbel R, Aboyans V, Boileau C, et al. 2014 esc guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The task force for the diagnosis and treatment of aortic diseases of the european society of cardiology (esc). European Heart Journal. 2014;35:2873-2926. doi: 10.1093/eurheartj/ehu281.
Ward C. Clinical significance of the bicuspid aortic valve. Heart. 2000;83:81-5. doi: 10.1136/heart.83.1.81.
E. Girdauskas, M. Rouman, K. Disha, A, et al. Borger, et al. Aortic dissection after previous aortic valve replacement for bicuspid aortic valve disease, Journal of the American College of Cardiology. 66 (2015) 1409–1411. doi: 10.1016/j.jacc.2015.07.022.
W.I. Schievink, S.S. Raissi, M.M. Maya, et al. Screening for intracranial aneurysms in patients with bicuspid aortic valve. Neurology. 74 (2010) 1430–1433. doi: 10.1212/WNL.0b013e3181dc1acf.
C. Egbe, R. Padang, R.D. Brown, et al. Prevalence and predictors of intracranial aneurysms in patients with bicuspid aortic valve. Heart. 103 (2017) 1508–1514. doi: 10.1136/heartjnl-2016-311076.
Allen BD, Markl M, Barker AJ, et al. Infl uence of beta-blocker therapy on aortic blood flow in patients with bicuspid aortic valve. The International journal of Cardiovascular Imaging. 2016; 32(4):621–628. doi:10.1007/s10554-015-0819-3. doi: 10.1007/s10554-015-0819-3.
Ohnemus D, Oster ME, Gatlin S, et al. The effect of angiotensin-converting enzyme inhibitors on the rate of ascending aorta dilation in patients with bicuspid aortic valve. Congenital Heart Disease. 2015; 10(1):E1–E5. doi:10.1111/chd.12184
Helmut Baumgartner, Volkmar Falk, Jeroen J. Bax, et all. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. European heart journal. 2017 sep 21;38(36):2739-2791. doi: 10.1093/eurheartj/ehx391.
Michelena HI, Katan O, Suri RM,et al. Incidence of infective endocarditis in patients with bicuspid aortic valves in the community. Mayo Clinic Proceedings. 2016;91:122-123. doi: 10.1016/j.mayocp.2015.10.011.
Michelena HI, Prakash SK, Della Corte A, et al. Bicuspid aortic valve: identifying knowledge gaps and rising to the challenge from the international bicuspid aortic valve consortium (bavcon). Circulation. 2014;129:2691-2704. doi: 10.1161/CIRULATİONAHA.113.007851.
Oliver JM, Alonso-Gonzalez R, Gonzalez AE, et al. Risk of aortic root or ascending aorta complications in patients with bicuspid aortic valve with and without coarctation of the aorta. The American Journal of Cardiology. 2009;104:1001-6. doi: 10.1016/j.amjcard.2009.05.045
Yener N, Oktar GL, Erer D, et al. Bicuspid aortic valve. Annals of Thoracic Cardiovascular Surgery. 2002; 8(5):264–267. pmid:12472407.
Smok DA: Aortopathy in pregnancy. Seminars in Perinatology. 2014, 38:295-303. doi: 10.1053/j.semperi.2014.04.019
Thorne SA. Pregnancy in heart disease. Heart. 2004; 90(4):450–456. doi: 10.1136/hrt.2003.027888.
Immer FF, Bansi AG, Immer-Bansi AS, et al. Aortic dissection in pregnancy: analysis of risk factors and outcome. Annals of Thoracic Cardiovascular Surgery. 2003; 76(1):309–314. doi: 10.1016/s0003-4975(03)00169-3.
McKellar SH, MacDonald RJ, Michelena HI, et al. Frequency of cardiovascular events in women with a congenitally bicuspid aortic valve in a single community and effect of pregnancy on events. The American Journal of Cardiology. 2011;107:96–99. doi: 10.1016/j.amjcard.2010.08.061.
Shah SY, Higgins A, Desai MY. Bicuspid aortic valve: basics and beyond. Clevelad Clinic Journal of Medicine. 2018, 85(10)779-784. doi: 10.3949/ccjm.85a.17069.
Hiratzka L, Bakris G, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease. Circulation. 2010; 121(13):e266–e369. doi:10.1161/CIR.0b013e3181d4739e.
Koh TW. Diagnosis of bicuspid aortic valve: role of three-dimensional transesophageal echocardiography and multiplane review analysis. Echocardiography a Journal of Cardiovascular Imaging and Intervention. 2013;30:360–3. doi: 10.1111/echo.12068.
Kiefer TL, Wang A, Hughes GC, et al. Management of patients with bicuspid aortic valve disease. Current Treatmant Options in Cardiovascular Medicine. 2011; 13(6):489–505. doi:10.1007/s11936-011-0152-7.
