Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-11-24T06:36:23.907Z Has data issue: false hasContentIssue false
  • English
  • Français

The aortic valve with two leaflets — a study in 2,000 autopsies

Published online by Cambridge University Press:  19 August 2008

Helder M. Pauperio ,
Arthur C. Azevedo  and
Claudia S. Ferreira
Helder M. Pauperio*
Affiliation:
Division of Paediatric Cardiology, Socor and Felicio Rocho Hospital, Belo Horizonte MG, Brazil.
Arthur C. Azevedo
Affiliation:
Division of Paediatric Cardiology, Socor and Felicio Rocho Hospital, Belo Horizonte MG, Brazil.
Claudia S. Ferreira
Affiliation:
Division of Paediatric Cardiology, Socor and Felicio Rocho Hospital, Belo Horizonte MG, Brazil.
*
Dr. Helder M. Pauperio, Hospital Socor, Av. Contorno 10.500, 30110–14 0 Belo Horizonte-MG, Brazil. Tel: 55313346076; Fax: 55312288200; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Our study is based on the examination of 2,000 aortic valves obtained from fresh cadavers (1,499 males, 501 females) at the Institute of Forensic Medicine in Rio de Janeiro. We discovered 13 valves having two leaflets, giving a prevalence of 0.65%, much lower than generally reported in the literature. All 13 valves were from males, 10 from whites, three from mulattos, and none from blacks. Special attention was given to the raphe and the leaflets, the calcification of which can lead to stenosis. The only valves with normal texture and flexibility were two obtained from children less than one year old. All the other valves were thickened, and five of them had some degree of calcification. Six valves were judged to be functioning normally, while 7 valves were abnormal, 5 being stenotic and two showing evidence of insufficiency. The insufficiency in one was due to endocarditis, but in the other was due to redundancy of the leaflets. The only other cardiac anomaly discovered in these 13 cases was one patient with aortic coarctation. Bifoliate aortic valve, therefore, is probably the most common cardiac anomaly, although its prevalence as discovered in Brazil is lower than that reported in the literature. It affects mainly white males. After the fourth decade of life, most valves present some thickening, with stenosis being the most common complication. As is well recognised, infective endocarditis and aortic insufficiency are the other frequent complications. It is in general, nonetheless, an isolated anomaly.

Keywords

Bifoliate aortic valvebicuspid aortic valveaortic valvar stenosisaortic insufficiencyaortic valvar disease
Type
Original Articles
Information
Cardiology in the Young , Volume 9 , Issue 5 , September 1999 , pp. 488 - 498
Copyright
Copyright © Cambridge University Press 1999

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Peacock, TB. Very great contraction of the aortic orifice from disease of the valves. Transactions of the Pathological Society of London 1868; 19:163–166.Google Scholar
2.Osier, W. The bicuspid condition of the aortic valves. Trans Ass AmerPhys. 1886.1: 185–192.Google Scholar
3.Lewis, T, Grant, RT. Observations relating to subacute infective endocarditis. Heart 1923; 10: 21–99.Google Scholar
4.McGin, S, White, PD. Clinical observations on aortic stenosis. Amer J Med Sci 1934: 188.Google Scholar
5.Karsner, HT, Koletsky, S. Calcific disease of the aortic valve. J.B. Lippincott, Philadelphia, 1947.Google Scholar
6.Smith, DE, Matthews, MB. Aortic valvular stenosis with coarctation of the aorta. With special reference to the development of aortic stenosis upon congenital bicuspid valves. Br Heart J;17: 198–206.CrossRefGoogle Scholar
7.Bayles, TB, Lewis, WH. Sub acute bacterial endocarditis in older people. Ann Intern Med 1940; 13: 2154–2163.Google Scholar
8.Bacon, APC, Matthews, MB. Congenital bicuspid aortic valves and the aetiology of isolated valvular stenosis. Quart J Med 1959; 28: 545–560.Google Scholar
9.Edwards, JE. The congenital bicuspid aortic valve. Circulation 1961; 23: 485–488.CrossRefGoogle ScholarPubMed
10.Roberts, WC. The congenital bicuspid aortic valve. A study of 85 autopsy cases. Am J Cardiol 1970; 26: 72–83.CrossRefGoogle ScholarPubMed
11.Roberts, WC. Anatomically isolated aortic valvular disease. The case against its being of rheumatic etiology. Am J Med 1970; 49: 151–159.CrossRefGoogle ScholarPubMed
12.Roberts, WC. Valvular, subvalvular and supravalvular aortic stenosis. Morphologic features. Cardiovasc Clin 1973; 5: 97–126.Google ScholarPubMed
13.Roberts, WC. The structure of the aortic valve in clinically isolated aortic stenosis. An autopsy study of 162 patients over 15 years of age. Circulation 1970; 42: 91–97.CrossRefGoogle Scholar
14.Nanda, NC, Gramiak, R, Manning, J, Mahoney, EB, Lipchick, EC, Deweese, JA. Echocardiographic recognition of the congenital bicuspid aortic valve. Circulation 1974; 49: 870–875.CrossRefGoogle ScholarPubMed
15.Zemma, MJ, Caccavano, M. Two dimensional echocardiographic assesment of aortic valve morphology: feasibility of bicuspid valve detection. Prospective study of 100 adult patients. Br Heart J 1982; 48: 428–133.CrossRefGoogle Scholar
16.Brandenburg, Ro Jr, Tajik, AJ, Edwards, WD, Reeder, GS, Shub, C, Seward, JB. Accuracy of 2 dimensional echocardiographic diagnosis of congenitally bicuspid aortic valve: echocardio-graqphic-anatomic correlation in 115 patients. Am J Cardiol 1983; 51: 1469–1473.CrossRefGoogle ScholarPubMed
17.Angelini, A, Ho, SY, Anderson, RH, Devine, WA, Zuberbuhler, RJ, Becker, AE. The morphology of the normal aortic valve as compared with the aortic valve having two leaflets. Thorac Cardiovasc Surg 1989; 98: 362–367.CrossRefGoogle ScholarPubMed
18.Keith, JD, Rowe, RD, Vlad, E. Heart disease in infancy and childhood. Macmillan Publishing Co., New York, Third Edition, 1978: 728–735.Google Scholar
19.Bound, JP, Logan, WE. Incidence of congenital heart disease in Blackpool 1957–1971. Br Heart J 1977; 39: 445–550.CrossRefGoogle ScholarPubMed
20.Mitchell, SC, Selman, AH, Westphal, MC, Park, J. Etiologic correlates in a study of congenital heart disease in 56.109 births. Amer J Cardiol 1971; 28: 653–657.CrossRefGoogle Scholar
21.Anderson, RH, Macartney, FJ, Shinebourne, EA, Tynan, M. Paediatric Cardiology. Churchil Livingstone London 1987. pp 977–999.Google Scholar
22.Duran, AC, Frescura, C, Sans-Coma, V, Angelini, A, Basso, C, Thiene, G. Bicuspid Aortic Valves in Hearts with Other Congenital Heart Disease The Journal of Heart Valve Disease 1995; 4: 581–590.Google ScholarPubMed
23.Waller, BF, Carter, JB, Williams, HJ, Wang, E, Edwards, JE. Bicuspid aortic valve. Comparison of congenital and acquired types. Circulation 1973; 48: 1140–1150.CrossRefGoogle ScholarPubMed
24.Campbell, M. The natural history of congenital aortic stenosis. BrHJ. 1968; 30: 514–20.Google ScholarPubMed
25.Ho, SY, Baker, EJ, Rigby, ML, Anderson, R. Congenital Heart Disease. Morphologic and Clinical Correlations. Mosby-Wolfe, London 1995 pp 117–124.Google Scholar
26.Beppu, S, Suzuki, S, Matsuda, H, Ohmori, F, Nagata, S, Miyatake, K. Rapidity of progression of aortic stenosis in patients with congenital bicuspid aortic valves. Am J Cardiol; 1993: Feb 1, 71: 322–327.CrossRefGoogle ScholarPubMed
27.Roberts, WC, Elliot, L.P. Lesions complicating a congenitally bicuspid aortic valve. Anatomic and radiographic features. Radiol. Clin North Am. 1968; 6: 409–21.Google Scholar
28.Fenoglio, JJ, Me Allister, HA, De Castro, CM, Davies, JE and Cheitlin, MD. Congenital bicuspid aortic valve after 20. Am J Cardiology 1977;30:164–169.CrossRefGoogle Scholar
29.Mills, P, Leech, G, Davies, M, Leatham, A. The natural history of a non stenotic bicuspid aortic valve. Brit Heart J. 1978; 40: 951–957.CrossRefGoogle ScholarPubMed
30.Becker, AE, Duren, DD. Spontaneous rupture of bicuspid aortic valve. Anusual cause of aortic insuficiency. Chest 1977;72,361–362.CrossRefGoogle Scholar
31.Arikawa, K, Chosa, N, Kinjoh, T, Masuda, H, Ishibe, R, Tabata, D, Nishimura, M, Morishita, Y, Taira, A. Pure aortic valve regurgitation due to congenital bicuspid valve analysis of 7 cases and a report of 2 rare cases. Nippon Kyobu Geka Gakkai Zasshi 1990: 12, 2401–2403.Google Scholar
32.Hahn, RT, Roman, MJ, Mogtader, AH, Devereux, RB. Association of aortic dilation with regurgitant, stenotic and functionally normal bicuspid aortic valves. J Am Coll Cardiol 1992 19: 283–288.CrossRefGoogle ScholarPubMed
33.Burks, JM, Illes, RW, Keating, EC, Lubbe, WJ. Ascending aortic aneurysm and dissection in young adults with bicuspid aortic valve: implications for echocardiographic surveillance. Clin Cardiol 1998, 21:439–443.CrossRefGoogle ScholarPubMed
34.Edwards, WD, Leaf, DS, Edwards, JE. Dissecting aortic aneurysm associated with congenital bicuspid aortic valve. Circulation 1978; 57: 1022–1025.CrossRefGoogle ScholarPubMed
35.Lindsay, J. Coarctation of te aorta, bicuspid aortic valve and abnormal ascending aortic wall. Am J Cardiol 1984; 53: 849–855Google Scholar
36.Roberts, CHS, Roberts, WC. Dissection of the aorta associated with congenital malformations of the aortic valve. J Am Coll Cardiol 1991; 17: 712–716.CrossRefGoogle ScholarPubMed
37.Edwards, JE. Pathologic aspects of cardiac valvular insufficiencies. Arch Surg 1958; 77: 634–649.Google ScholarPubMed
38.Maizza, AE, Ho, SY, Anderson, RH. Obstruction of the left ventricular outflow tract: Anatomical observations and surgical implications. The Journal of Heart Valve Disease 1993;2: 66–79.Google ScholarPubMed
39.Roberts, WC, Morrow, AG, Mclntosh, CI, Jones, M, Epstein, SE. Congenitally bicuspid aortic valve causing severe, pure aortic regurgitation without superimposed infective endocarditis. Analysis of 13 patients requiring aortic valve replacement. Am J Cardiol 1981; 47: 206–209.CrossRefGoogle ScholarPubMed
40.Sadee, AS, Becker, AE, Verheul, HA, Bouma, B, Hoedemaker, G. Aortic valve regurgitation and the congenitally bicuspid aortic: a clinico-pathological correlation Br Heart J 1992; 67: 439–41.CrossRefGoogle ScholarPubMed
41.Abbot, ME. Coarctation of the aorta of adult type: a statistical study and historical retrospect of 200 recorded cases with autopsy of stenosis or obliteration of the descending aorta in subjects over the age oftwo years. Am Heart J 1928; 3: 574–618Google Scholar
42.Reifenstein, GH, Levine, AS, Gross, RE. Coarctation of the aorta: a review of 104 autopsied cases of the adult type, 2 years of age or older. Am Heart J 1947; 33: 146–168.CrossRefGoogle ScholarPubMed
43.Hutchins, GM. Coarctation of the aorta as a branch point of the ductus arteriosus. Am J Pathol 1971; 63: 203–214.Google ScholarPubMed
44.Tawes, RL. Congenital bicuspid aottic valves with coarctation of the aorta in children. Br Heart J 1969; 31: 127–128.CrossRefGoogle ScholarPubMed
45.Becker, AE, Becker, MJ, Edwards, JE. Anoriialies associated with coarctation of the aorta: particular reference to infancy. Circulation 1970;41: 1067–1705.CrossRefGoogle ScholarPubMed