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      Current and Future Aspects of Multimodal Imaging, Diagnostic, and Treatment Strategies in Bicuspid Aortic Valve and Associated Aortopathies

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          Abstract

          Bicuspid aortic valve (BAV) is the most frequent congenital cardiac abnormality leading to premature aortic valve apparatus dysfunction and is often associated with aortopathy. Therefore, current guidelines recommend a surgical aortic valve replacement (SAVR), even if many patients are deemed inoperable owing to their comorbidities and require alternatives such as transcatheter aortic valve replacement (TAVR). However, BAV variations remain challenging for procedural success. Therefore, the latest development in different imaging modalities (echocardiography, multislice-computertomographie, cardiovascular magnetic resonance) allows in-depth analysis for preprocedural risk stratification, follow up, and patient selection. Furthermore, we shed light on the latest developments in pre- and periprocedural fusion imaging as well as on current and future treatment options.

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          Most cited references45

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          A classification system for the bicuspid aortic valve from 304 surgical specimens.

          In general, classification of a disease has proven to be advantageous for disease management. This may also be valid for the bicuspid aortic valve, because the term "bicuspid aortic valve" stands for a common congenital aortic valve malformation with heterogeneous morphologic phenotypes and function resulting in different treatment strategies. We attempted to establish a classification system based on a 5-year data collection of surgical specimens. Between 1999 and 2003 a precise description of valve pathology was obtained from operative reports of 304 patients with a diseased bicuspid aortic valve. Several different characteristics of bicuspid aortic valves were tested to generate a pithy and easily applicable classification system. Three characteristics for a systematic classification were found appropriate: (1) number of raphes, (2) spatial position of cusps or raphes, and (3) functional status of the valve. The first characteristic was found to be the most significant and therefore termed "type." Three major types were identified: type 0 (no raphe), type 1 (one raphe), and type 2 (two raphes), followed by two supplementary characteristics, spatial position and function. These characteristics served to classify and codify the bicuspid aortic valves into three categories. Most frequently, a bicuspid aortic valve with one raphe was identified (type 1, n = 269). This raphe was positioned between the left (L) and right (R) coronary sinuses in 216 (type 1, L/R) with a hemodynamic predominant stenosis (S) in 119 (type 1, L/R, S). Only 21 patients had a "purely" bicuspid aortic valve with no raphe (type 0). A classification system for the bicuspid aortic valve with one major category ("type") and two supplementary categories is presented. This classification, even if used in the major category (type) alone, might be advantageous to better define bicuspid aortic valve disease, facilitate scientific communication, and improve treatment.
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            Cardiac 3D Printing and its Future Directions.

            Three-dimensional (3D) printing is at the crossroads of printer and materials engineering, noninvasive diagnostic imaging, computer-aided design, and structural heart intervention. Cardiovascular applications of this technology development include the use of patient-specific 3D models for medical teaching, exploration of valve and vessel function, surgical and catheter-based procedural planning, and early work in designing and refining the latest innovations in percutaneous structural devices. In this review, we discuss the methods and materials being used for 3D printing today. We discuss the basic principles of clinical image segmentation, including coregistration of multiple imaging datasets to create an anatomic model of interest. With applications in congenital heart disease, coronary artery disease, and surgical and catheter-based structural disease, 3D printing is a new tool that is challenging how we image, plan, and carry out cardiovascular interventions.
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              Aortic dilatation in patients with bicuspid aortic valve.

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                Author and article information

                Journal
                J Clin Med
                J Clin Med
                jcm
                Journal of Clinical Medicine
                MDPI
                2077-0383
                01 March 2020
                March 2020
                : 9
                : 3
                : 662
                Affiliations
                [1 ]Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Moorenstr. 5, 40225 Düsseldorf, Germany; Shazia.Afzal@ 123456med.uni-duesseldorf.de (S.A.); Kerstin.Piayda@ 123456med.uni-duesseldorf.de (K.P.); Oliver.Maier@ 123456med.uni-duesseldorf.de (O.M.); Shouheng.Goh@ 123456med.uni-duesseldorf.de (S.G.); Katharina.Hellhammer@ 123456med.uni-duesseldorf.de (K.H.); Mareike.Cramer@ 123456med.uni-duesseldorf.de (M.C.); Florian.Boenner@ 123456med.uni-duesseldorf.de (F.B.); amin.polzin@ 123456med.uni-duesseldorf.de (A.P.); malte.kelm@ 123456med.uni-duesseldorf.de (M.K.); zeus@ 123456med.uni-duesseldorf.de (T.Z.)
                [2 ]Philips Healthcare, 5684 Best, The Netherlands; Niels.Nijhof@ 123456philips.com
                [3 ]CARID (Cardiovascular Research Institute Düsseldorf), Moorenstr. 5, 40225 Düsseldorf, Germany
                Author notes
                Author information
                https://orcid.org/0000-0002-6312-8146
                https://orcid.org/0000-0002-9746-7592
                https://orcid.org/0000-0002-7277-1213
                https://orcid.org/0000-0002-2744-2154
                Article
                jcm-09-00662
                10.3390/jcm9030662
                7141257
                32121483
                40bbf4a9-d2c4-4966-96f7-b67ecef41078
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 21 January 2020
                : 25 February 2020
                Categories
                Review

                aortopathy,congenital heart disease,bicuspid aortic valve

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