ACA App
Annals of Cardiac Anaesthesia Annals of Cardiac Anaesthesia Annals of Cardiac Anaesthesia
Home | About us | Editorial Board | Search | Ahead of print | Current Issue | Archives | Submission | Subscribe | Advertise | Contact | Login 
Users online: 1052 Small font size Default font size Increase font size Print this article Email this article Bookmark this page
 


 

 
     
    Advanced search
 

 
 
     
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  


    References
    Article Figures

 Article Access Statistics
    Viewed2346    
    Printed42    
    Emailed1    
    PDF Downloaded159    
    Comments [Add]    

Recommend this journal

 


 
Table of Contents
INTERESTING IMAGE  
Year : 2014  |  Volume : 17  |  Issue : 1  |  Page : 40-41
Unicommissural unicuspid aortic valve


Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

Click here for correspondence address and email

Date of Web Publication2-Jan-2014
 

How to cite this article:
Montealegre-Gallegos M, Shakil O, Jiang L, Mahmood F. Unicommissural unicuspid aortic valve. Ann Card Anaesth 2014;17:40-1

How to cite this URL:
Montealegre-Gallegos M, Shakil O, Jiang L, Mahmood F. Unicommissural unicuspid aortic valve. Ann Card Anaesth [serial online] 2014 [cited 2019 Sep 23];17:40-1. Available from: http://www.annals.in/text.asp?2014/17/1/40/124135


A 39-year-old man with no relevant past medical history was evaluated for progressive light headedness, exertional dyspnea and chest pain. Transthoracic echocardiography (TTE) revealed a severely stenotic unicuspid aortic valve (AV), with mean and peak pressure gradients of 48 and 96 mmHg, respectively and AV area of 0.8 cm 2 . Moderate aortic regurgitation was also present. The coronary angiogram was normal. The patient was scheduled for an aortic valve replacement. Intraoperative transesophageal echocardiography (TEE) confirmed the presence of a stenotic unicuspid AV with a single commissure located posteriorly [Figure 1], [Panel a]. The ascending aorta was mildly dilated with normal sinuses of Valsalva and sinotubular junctions [Figure 1], [Panel b]. Three-dimensional TEE revealed a characteristic, teardrop-shaped eccentric valve orifice with a unicommissural, unicuspid AV [Figure 1], [Panel c] [Video 1]

. Upon examination, the unicuspid leaflet was fibrotic with focal calcifications [Figure 2]. The valve was excised and replaced with a 23 mm mechanical valve. The patient had an uneventful recovery from the procedure.
Figure 1: 2-dimensional transesophageal echocardiographic images on the midesophageal aortic valve (AV) short axis (Panel a) and midesophageal AV long axis (Panel b) show the commissure of the valve and the stenotic orifice. A 3-dimensional transesophageal echocardiographic image (Panel c) en face view of the AV confirmed the findings

Click here to view
Figure 2: The unicuspid valve is shown after surgical resection

Click here to view


A unicuspid aortic valve is a rare congenital abnormality, with reported incidence of 0.02% in patients undergoing echocardiographic studies. [1] These valves may be unicommissural, with the commissural attachment to the aorta situated posteriorly in the majority of cases, or acommissural with no attachment to the aorta. The valve orifice in unicommissural valves is eccentric and elongated; while in acommissural valves it is central and pinhole-shaped. The acommissural variant is usually symptomatic at birth or during childhood, whereas the unicommissural type usually develops symptoms until adulthood. Both types are prone to early degeneration, causing aortic stenosis and regurgitation. Unicuspid AV is also frequently associated with dilation of the ascending aorta and aortic aneurysm. [2]

 
   References Top

1.Novaro GM, Mishra M, Griffin BP. Incidence and echocardiographic features of congenital unicuspid aortic valve in an adult population. J Heart Valve Dis 2003;12:674-8.  Back to cited text no. 1
[PUBMED]    
2.Chu JW, Picard MH, Agnihotri AK, Fitzsimons MG. Diagnosis of congenital unicuspid aortic valve in the adult population: The value and limitation of transesophageal echocardiography. Echocardiography 2010;27:1107-12.  Back to cited text no. 2
[PUBMED]    

Top
Correspondence Address:
Mario Montealegre-Gallegos
Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, One Deaconess Road, CC-470, Boston, MA 02215
USA
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.124135

Rights and Permissions


    Figures

  [Figure 1], [Figure 2]



 

Top