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. 1978 Sep;40(9):941–950. doi: 10.1136/hrt.40.9.941

The diagnosis of a non-stenotic bicuspid aortic valve.

G Leech, P Mills, A Leatham
PMCID: PMC483514  PMID: 708534

Abstract

Follow-up of a group of subjects in whom an aortic ejection sound was the only abnormal finding revealed a bicuspid aortic valve at necropsy or operation in 6 cases. High speed echophonocardiographic studies in 15 subjects with aortic stenosis and known to have bicuspid valves, showed the ejection sound to be exactly synchronous with final halting of the opening aortic valve cusps. Echocardiographic visualisation of the aortic valve from the apex, looking up the left ventricular outflow tract, showed valve echoes during systole indicating abnormal cusp configuration. This proved a more sensitive indicator of a bicuspid aortic valve than the finding of an eccentric aortic valve closure line. These findings were used to evaluate 37 subjects with the auscultatory finding of an isolated aortic ejection sound and the diagnosis of a non-stenotic bicuspid aortic valve was confirmed in 30. The usual cause of misdiagnosis was a sound associated with late tricuspid valve closure. The auscultatory finding of an aortic ejection sound, in the absence of other signs of aortic stenosis, indicates a non-stenotic, bicuspid aortic valve. Confirmation of aortic valvar origin of the sound can be provided by a simultaneous echophonocardiogram.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. EPSTEIN E. J., COULSHED N. ASSESSMENT OF AORTIC STENOSIS FROM THE EXTERNAL CAROTID PULSE WAVE. Br Heart J. 1964 Jan;26:84–96. doi: 10.1136/hrt.26.1.84. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. EPSTEIN E. J., CRILEY J. M., RAFTERY E. B., HUMPHRIES J. O., ROSS R. S. CINERADIOGRAPHIC STUDIES OF THE EARLY SYSTOLIC CLICK IN AORTIC VALVE STENOSIS. Circulation. 1965 Jun;31:842–853. doi: 10.1161/01.cir.31.6.842. [DOI] [PubMed] [Google Scholar]
  3. GAMBOA R., HUGENHOLTZ P. G., NADAS A. S. ACCURACY OF THE PHONOCARDIOGRAM IN ASSESSING SEVERITY OF AORTIC AND PULMONIC STENOSIS. Circulation. 1964 Jul;30:35–46. doi: 10.1161/01.cir.30.1.35. [DOI] [PubMed] [Google Scholar]
  4. Glancy D. L., Epstein S. E. Differential diagnosis of type and severity of obstruction to left ventricular outflow. Prog Cardiovasc Dis. 1971 Sep;14(2):153–191. doi: 10.1016/0033-0620(71)90052-1. [DOI] [PubMed] [Google Scholar]
  5. Glancy D. L., Morrow A. G., Roberts W. Malformations of the aortic valve in patients with the tetralogy of Fallot. Am Heart J. 1968 Dec;76(6):755–759. doi: 10.1016/0002-8703(68)90260-3. [DOI] [PubMed] [Google Scholar]
  6. HANCOCK E. W. Differentiation of valvar, subvalvar and supravalvar aortic stenosis. Guys Hosp Rep. 1961;110:1–30. [PubMed] [Google Scholar]
  7. LEATHAM A., SEGAL B., SHAFTER H. AUSCULTATORY AND PHONOCARDIOGRAPHIC FINDINGS IN HEALTHY CHILDREN WITH SYSTOLIC MURMURS. Br Heart J. 1963 Jul;25:451–459. doi: 10.1136/hrt.25.4.451. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. LEATHAM A., VOGELPOEL L. The early systolic sound in dilatation of the pulmonary artery. Br Heart J. 1954 Jan;16(1):21–33. doi: 10.1136/hrt.16.1.21. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Letham A., Leech G. Proceedings: Observations on realtion between heart sounds and valve movements by simultaneous echoand phonocardiography. Br Heart J. 1975 May;37(5):557–557. [PubMed] [Google Scholar]
  10. Nanda N. C., Gramiak R., Manning J., Mahoney E. B., Lipchik E. O., DeWeese J. A. Echocardiographic recognition of the congenital bicuspid aortic valve. Circulation. 1974 May;49(5):870–875. doi: 10.1161/01.cir.49.5.870. [DOI] [PubMed] [Google Scholar]
  11. Oakley C. M., Hallidie-Smith K. A. Assessment of site and severity in congenital aortic stenosis. Br Heart J. 1967 May;29(3):367–379. doi: 10.1136/hrt.29.3.367. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Radford D. J., Bloom K. R., Izukawa T., Moes C. A., Rowe R. D. Echocardiographic assessment of bicuspid aortic valves. Angiographic and pathological correlates. Circulation. 1976 Jan;53(1):80–85. doi: 10.1161/01.cir.53.1.80. [DOI] [PubMed] [Google Scholar]
  13. Roberts W. C. The congenitally bicuspid aortic valve. A study of 85 autopsy cases. Am J Cardiol. 1970 Jul;26(1):72–83. doi: 10.1016/0002-9149(70)90761-7. [DOI] [PubMed] [Google Scholar]
  14. SMITH D. E., MATTHEWS M. B. Aortic valvular stenosis with coarctation of the aorta, with special reference to the development of aortic stenosis upon congenital bicuspid valves. Br Heart J. 1955 Apr;17(2):198–206. doi: 10.1136/hrt.17.2.198. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Waider W., Craige E. First heart sound and ejection sounds. Echocardiographic and phonocardiographic correlation with valvular events. Am J Cardiol. 1975 Mar;35(3):346–356. doi: 10.1016/0002-9149(75)90026-0. [DOI] [PubMed] [Google Scholar]
  16. Weissler A. M., Harris W. S., Schoenfeld C. D. Systolic time intervals in heart failure in man. Circulation. 1968 Feb;37(2):149–159. doi: 10.1161/01.cir.37.2.149. [DOI] [PubMed] [Google Scholar]

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