Morfología de la válvula aórtica bicúspide y dilatación aórtica

Marco Durán A., Paola Mendieta C., Isabel Freire B.

Resumen


Introducción: la válvula aórtica bicúspide (VAB) es una de las cardiopatías congénitas más frecuentes y además de causar alteraciones en la función valvular, es común encontrar afectación de la arteria aorta. Metodología: estudio observacional, descriptivo y retrospectivo. En el servicio de consulta externa del hospital Roberto Gilbert se revisaron los registros ecocardiográficos de pacientes con diagnóstico de VAB entre abril 2017 y abril 2019. Resultados: de 8.000 registros ecocardiográficos revisados se encontraron 71 niños con el diagnóstico de VAB dando una prevalencia del 0,9% con una clara superioridad del sexo masculino (76,4%). Lesiones funcionales valvulares se registraron en el 55,55% de la población sin que se encuentre predominancia de la estenosis o de la insuficiencia. La dilatación aórtica se encontró en 24 pacientes (33%) siendo el segmento de los senos de Valsalva, el mayormente afectado. Conclusiones: la prevalencia de VAB en el presente estudio se encuentra entre los valores publicados. Es frecuente la presencia de lesiones valvulares y dilatación de la aorta. Después del diagnóstico, la vigilancia y el seguimiento se vuelven muy importantes para prevenir eventos catastróficos y el momento del tratamiento intervencionista. Se recomienda descartar VAB en familiares de primer grado.


Palabras clave


ecocardiografía; válvula aórtica bicúspide; dilatación de aorta

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Referencias


Basso C, Boschello M, Perrone C, Mecenero A, et al An Echocardiographic Survey of Primary School Children for Bicuspid Aortic Valve Am J Cardiol 2004;93:661–663

Tutar E, Ekici F, Atalay S, Nacar N The prevalence of bicuspid aortic valve in newborns by echocardiographic screening Am Heart J 2005;150:513-515

Braverman AC, Guven H, Beardslee MA, Makan M, et al The bicuspid aortic valve Curr Probl Cardiol 2005;30:470-522

Mordi I, Tzemos N Bicuspid Aortic Valve Disease: A Comprehensive Review Cardiology Research and Practice Volume 2012, Open access Article ID 196037, 7 pages doi:10.1155/2012/196037

Schaefer BM, Lewin MB, Stout KK, Gill E, et al The bicuspid aortic valve: an integrated phenotypic classifica-tion of leaflet morphology and aortic root shape Heart 2008; 94:1634–1638 (Consulta: 7 Octubre 2014) Dis-ponible en heart.bmj.com

Cecconi M, Nistri S, Quarti A, Manfrin M, et al Aortic dilatation in patients with bicuspid aortic valve. J Car-diovasc Med 2006;7:11-20

Hahn RT, Roman MJ, Mogtader AH, Devereux RB Association of Aortic Dilation With Regurgitant, Stenotic and Functionally Normal Bicuspid Aortic Valves J Am Col Cardiol 1992;19:283-288

Pauperio HM, Azevedo AC, Ferreira CS The aortic valve with two leaflets - a study in 2,000 autopsies Cardiol Young 1999;9:488-498

Fernandez B, Duran AC, Fernandez-Gallego T, Fernandez MC, et al Bicuspid aortic valves with different spa-tial orientation of the leaflets are distinct etiological entities J Am Col Cardiol 2009;54:2312-2318

Anderson RH, Webb S, Brown NA, Lamers W, et al Development of the heart; (3) Formation of the ventricular outflow tracts, arterial valves and intrapericardial arterial trunks Heart ( Consulta: 19 Septiembre 2019) Dis-ponible en http://www.heart.bmj.com/

Pedersen MW, Groth KA, Mortensen KH, Brodersen J, et al Clinical and pathophysiological aspects of bicus-pid aortic valve disease Cardiology in the Young 29:1–10. Disponible en https://www.cambridge.org/core. Ka-rolinska Institutet University Library, on 25 Jan 2019

Fedak PWM, Verma S, David TE, Leask RL, et al Clinical and Pathophysiological Implications of a Bicuspid Aortic Valve Circulation 2002;106:900-904 (Consulta: 14 Julio 2019) Disponible en http://www.ahajournals.org

Siu SC, Silversides CK Bicuspid aortic valve disease J Am Coll Cardiol 2010;55:2789-2800

Prakash SK, Bossé Y, Muehlschlegel JD, Michelena HI, et al A road map to investigate the genetic basis of bi-cuspid aortic valve and its complications Insights from the international BAV Consortium J Am Coll Cardiol 2014;64:832:839

Robicsek F, Mano JT, Cook JW, Fowler B The Congenitally Bicuspid Aortic Valve: How Does It Function? Why Does It Fail? Ann Thorac Surg. 2004;77:177-185

Szeto K, Pastuszko P, del Alamo JC, Lasheras J, et al Bicuspid Aortic Valves Experience Increased Strain as Compared to Tricuspid Aortic Valves (Consulta: 17 Junio 2015) Disponible en pch.sagepub.com at SIMON FRASER LIBRARY

Kong WKF, Delgado V, Poh KK, Regeer MV, et al Prognostic implications of raphe in bicuspid aortic valve anatomy (Consulta: 01 Abril 2917) Disponible en: http://cardiology.jamanetwork.com/ by a GAZI UNIVERSI-TESI User

Fernandes SM, Sanders SP, Khairy P, Jenkins KJ, et al Morphology of bicuspid aortic valve in children and adolescents J Am Col Cardiol 2004;44;1648-1651

Evangelista A, Gallego P, Calvo-Iglesias F, Bermejo J, et al Anatomical and clinical predictors of valve dys-function and aortic dilation in bicuspid aortic valve disease Heart 2018;104:566–573 (Consulta:31Mayo2019) Disponible en http://www.heart.bmj.com/Heart

Fernandes SM, Khairy P, Sanders SP, Colan SD Bicuspid aortic valve Morphology and interventions in the young J Am Coll Cardiol 2007; 49:2211-2214

Tripathi A, Wang Y, Jerrell JM Population based treated prevalence, risk factors, and outcomes of bicuspid aortic valve in a pediatric Medicaid cohort Ann Pediatr Card 2018;11:119-24 (Consulta: 03 Mayo 2019) Dis-ponible libre en http://www.annalspc.com

Michelena HI, Desjardins VA, Avierinos J-F, Russo A, et al Natural history of asymptomatic patients with normally functioning or minimally dysfunctional bicuspid aortic valve in the Community Circulation 2008;117:2776-2784 ( Consulta: 19 Febrero 2019) Disponible en http://www.circ.ahajournals.org

Ciotti GR, Vlahos AP, Silverman NH Morphology and function of the bicuspid aortic valve with and without coartaction af the aorta in the young Am J Cardiol 2006;98:1096-1102

Merky R, Duijnhouwer AL, Vink E, Roos-Hesselink JE, et al Aortic diameter growth in children with bicuspid aortic valve Am J Cardiol 2017; 120: 131-136 (Consulta: Marzo 2019) Disponible libre en http://creativecommons.org/licenses/by/4.0/

Mart CR, McNerny BE Shape of the dilated aorta in children with bicuspid aortic valve Annals of Pediatric Cardiology 2013;6:126-131 (Consulta: 7 Noviembre 2017) Disponible libre en http://www.annalspc.com

Cecconi M, Manfrin M, Moraca A, Zanoli R, et al Aortic dimensions in patients with Bicuspid Aortic Valve without significant valve dysfunction Am J Cardiol 2005;95:292–294

Khoo C, Cheung C, Jue J Patterns of aortic dilation in bicuspid aortic valve-associated aortopathy J Am Soc Echocardiogr 2013;26:600-605

Della Corte A, Bancone C, Quarto C, Dialetto G, et al Predictors of ascending aortic dilatation with bicuspid aortic valve: A wide spectrum of disease expression European Journal of Cardio-thoracic Surgery 2007;31:397-405 (Consulta: 31 Julio 2019) Disponible en https://academic.oup.com/ejcts/article-abstract/31/3/397/509476

Tadros TM, Klein MD, Shapira, OM Ascending Aortic Dilatation Associated With Bicuspid Aortic Valve Pathophysiology, Molecular Biology, and Clinical Implications Circulation 2009;119:880-890 (Consulta: 04 Diciembre 2017) Disponible en http://circ.ahajournals.org

Den Reijer PM, Sallee III D, van der Velden P, Zaaijer ER, et al Hemodynamic predictors of aortic dilatation in bicuspid aortic valve by velocity-encoded cardiovascular magnetic resonance Journal of cardiovascular mag-netic resonance 2010;12:4 Downloaded from http://www.jcmr-online.com/content/12/1/4

Hope MD, Hope TA, Meadows AK, Ordovas KG, et al Bicuspid Aortic Valve: Four-dimensional MR evaluation of ascending aortic systolic flow patterns Radiology: 2010; 255:53-61

Rodríguez-Palomares JF, Dux-Santoy L, Guala A, Kale R, et al Aortic flow patterns and wall shear stress maps by 4D-flow cardiovascular magnetic resonance in the assessment of aortic dilatation in bicuspid aortic valve disease J Cardiovasc Magn Reson 2018;20:28 Disponible en: https://doi.org/10.1186/s12968-018-0451-1

Longobardo L, Jain R, Carerj S, Zito C,et al Bicuspid Aortic Valve: Unlocking the morphogenetic puzzle, The American Journal of Medicine 2016;129:796-805

Beroukhim RS, Kruzick TL, Taylor AL , Gao D, et al Progression of aortic dilation in children with a functiona-lly normal bicuspid aortic valve Am J Cardiol 2006; 98:828-830

Girdauskas E, Borger MA, Secknus MA, Girdauskas G, et al Is aortopathy in bicuspid aortic valve disease a congenital defect or a result of abnormal hemodynamics? A critical reappraisal of a one-sided argument Eu-ropean Journal of Cardio-thoracic Surgery 2011; 39:809-814.




DOI: https://doi.org/10.23878/medicina.v23i3.1164



Revista Medicina - Universidad Católica de Santiago de Guayaquil - Facultad de Ciencias Médicas