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Dilatation of annulus of aortic valve — Clinical Guidelines

Overview

Dilatation of the aortic annulus in the context of bicuspid aortic valves increases the risk of aortic dissection and other complications. Management decisions are guided by the degree of aortic root or ascending aortic dilatation.

Diagnosis

Echocardiography: Essential for measuring aortic root dimensions, particularly at the sinuses of Valsalva 3.

Reference Standards: Comprehensive echocardiography by a cardiac sonographer for accurate measurements 3.

Inter-rater Reliability: Strong concordance between sports medicine physicians and cardiac sonographers in measuring aortic root diameter 3.

Management

Surgical Intervention: Recommended for severe aortic root or ascending aortic dilatation, with specific thresholds varying between guidelines 1 2.

Threshold Consensus: Subcommittee recommendations aim to harmonize surgical thresholds for bicuspid aortic valve patients 1 2.

Monitoring: Regular echocardiographic follow-up to assess progression of aortic dilatation 1.

Special Populations

Athletes: Focused echocardiography by trained physicians can serve as a screening tool for aortic root dilatation 3.

Key Recommendations

Define Surgical Thresholds: Establish consistent thresholds for surgical intervention in bicuspid aortic valve patients with aortic dilatation to mitigate dissection risk (Evidence: Expert opinion) 1 2.

Regular Monitoring: Implement routine echocardiographic surveillance for patients with bicuspid aortic valves to detect progressive aortic dilatation (Evidence: Moderate) 1.

Utilize Echocardiography: Employ echocardiography, particularly focused assessments by trained physicians, for accurate measurement and screening of aortic root dimensions (Evidence: Strong) 3.

References

1 Hiratzka LF, Creager MA, Isselbacher EM, Svensson LG, Nishimura RA, Bonow RO et al.. Surgery for Aortic Dilatation in Patients With Bicuspid Aortic Valves: A Statement of Clarification From the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology 2016. link 2 Hiratzka LF, Creager MA, Isselbacher EM, Svensson LG, Nishimura RA, Bonow RO et al.. Surgery for Aortic Dilatation in Patients With Bicuspid Aortic Valves: A Statement of Clarification From the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2016. link 3 Yim ES, Kao D, Gillis EF, Basilico FC, Corrado GD. Focused physician-performed echocardiography in sports medicine: a potential screening tool for detecting aortic root dilatation in athletes. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine 2013. link

Dilatation of annulus of aortic valve