Bicuspid aortic valve and echographic assessment of intracardiac hemodynamic changes (literature review and clinical observation)

Abstract

The presented work describes and analyzes the clinical case of a patient with a diagnosed bicuspid aortic valve, which led to functional mitral stenosis, which was eliminated after surgical intervention on the aortic valve. This clinical observation can be of practical interest both for doctors of therapeutic and surgical practice and for ultrasonographers, as it demonstrates the possibility of eliminating functional mitral stenosis by correcting hemodynamic disturbances caused by aortic insufficiency. In the described clinical case, functional mitral stenosis occurred as a result of dorsal displacement and insufficient opening of the anterior leaflet of the mitral valve in diastole, caused by the regurgitation flow of blood from the aorta into the left ventricle through the bicuspid aortic valve. A bicuspid aortic valve accompanied by aortic insufficiency does not in all clinical cases lead to such a regurgitation flow that displaces the anterior leaflet of the mitral valve and causes functional mitral stenosis. Since the bicuspid aortic valve has three morphological forms, it is likely that the absence of the left valve causes such a hemodynamic disturbance. In our opinion, the study of the relationship between the morphological forms of the bicuspid aortic valve and the hemodynamic disturbances caused by it has prospects for further research. The article also provides a brief review of the literature on the prevalence, causes, phenotypes of bicuspid aortic valve, as well as hemodynamic intracardiac changes and echographic diagnosis of bicuspid aortic valve disease.