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Archives of cardiovascular diseases
Volume 106, n° 5
pages 295-302 (mai 2013)
Doi : 10.1016/j.acvd.2012.11.005
Received : 3 July 2012 ;  accepted : 14 November 2012
Assessment of valvular surfaces in children with a congenital bicuspid aortic valve: Preliminary three-dimensional echocardiographic study
Estimation des surfaces valvulaires en cas de bicuspidie aortique chez l’enfant : une étude préliminaire d’échocardiographie tridimensionnelle

Figure 1

Figure 1 : 

Measurement of aortic cusp surfaces by planimetry using the multiplanar review mode. A. Schematic representation of the different types of bicuspid aortic valve (BAV) according to the classification described by Sievers and Schmidtke. BAV type 0 has two cusps with no raphe and BAV type 1 has three cusps with one raphe. Raphes are represented by black lines. In type 0, ap and lat refer to the spatial position of the cusps. In type 1, the position of the raphe is indicated by L-R (between the left and right coronary sinuses), R-N (between the right and non-coronary sinuses) and N-L (between the non-coronary and left coronary sinuses). The small/large cusp ratio corresponds to the surface of the white cusp/surface of the blue cusp ratio. Adapted from Sievers and Schmidtke [8]. B. Real-time transthoracic three-dimensional echocardiography of a pure BAV (type 0 ap). This valve is perfectly symmetrical as shown by measurement of the cusp surfaces. C. Multiplanar review mode from three-dimensional acquisition with the three orthogonal cutting plans. Cropping allows perfect visualization of the valve in a short-axis plane. Ap: anterior-posterior; lat: lateral; L: left coronary sinus; N: non-coronary sinus; R: right coronary sinus.

Figure 2

Figure 2 : 

Receiver operating characteristic curve analysing the ability of valvular asymmetry to discriminate stenotic from non-stenotic bicuspid aortic valves. The valvular asymmetry is expressed by the small/large cusp ratio. Area under the curve is 0.89 with a 95% confidence interval of 0.82 to 0.97. The best cut-off value to distinguish the stenotic from the non-stenotic valve is 0.75, with 84% sensitivity and 83% specificity.

Figure 3

Figure 3 : 

Linear regression analysis showing the relationship between valvular asymmetry and aortic stenosis. A. The degree of stenosis is represented by the maximal instantaneous aortic Doppler gradient. Linear regression analysis shows a good relationship (r =–0.6379, P <0.001) with valvular asymmetry expressed by the small/large cusp ratio. B. The degree of aortic stenosis is represented by the mean instantaneous aortic Doppler gradient and linear regression analysis shows a good relationship (r =–0.6102, P <0.001) with valvular asymmetry. Red lines represent regression lines.

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