The frequency of congenitally bicuspid aortic valves in patients having cardiac transplantation (CT) is unknown. We reviewed 243 explanted hearts in patients having CT at Baylor University Medical Center, Dallas from June 1997 through November 2011 to determine the frequency of a bicuspid aortic valve in this population. Of the 243 explanted hearts, 7 (2.9%) were found to have a congenitally bicuspid aortic valve: 3 had severe aortic valve stenosis and before CT had had the aortic valve replaced; the other 4 had normally functioning bicuspid valves and underwent CT for cardiomyopathy (ischemic in 1, idiopathic in 2, and hypertrophic in 1). Review of previously published reports of CT and aortic valve disease disclosed that 4 patients had had aortic valve replacement (AVR) from 2 to 8 years before CT, 3 had AVR or aortic valve repair of the donor heart at the time of CT, and 4 had AVR or transcatheter aortic valve implantation from 1 to 14 years after CT. Some of these aortic valve replacements, before, at the time of, or after CT were in patients with congenitally bicuspid aortic valves. In conclusion, congenitally bicuspid aortic valves were found in 7 of 243 explanted hearts in patients having CT at a single medical center in a 14-year period: 4 had functioned normally and 3 were severely stenotic. Previous reports of patients having AVR or repair before, during, and after CT were reviewed.
Cardiac transplantation (CT) is performed mainly in patients with ischemic or idiopathic dilated cardiomyopathy and infrequently in patients with valvular heart disease. This report describes the frequency of finding a bicuspid aortic valve in patients undergoing CT at a single medical center in a 14-year period and reviews previously published reports of patients having aortic valve replacement (AVR) or repair before, at the time of, and after CT.
Methods
From June 1997 through November 2011, CT was performed at Baylor University Medical Center, Dallas in 243 patients and in each the recipient heart was submitted to the cardiovascular division of the surgical pathology department. Each heart was examined and described by 1 of the authors (W.C.R.) and photographed. Among the 243 hearts studied, 9 had structural (primary) cardiac valve disease: 1 had had mitral valve replacement 2 times, originally for rheumatic mitral stenosis; 1 had replacement of both mitral and aortic valves for pure regurgitation secondary to radiation therapy for Hodgkin’s disease many years previously; and the remaining 7 patients had congenitally bicuspid aortic valves, 3 stenotic valves had been replaced and the other 4 were functionally normal ( Table 1 ).
| Patient Number | Age at CT (years) | Diagnosis | AVR | Year of AVR | Interval (years) AVR → CT | LVAD | BMI (kg/m 2 ) | LVEF (%) | Date of CT | HW (g) | LV Diameter (cm) | RV Diameter (cm) | CABG | CABG Date | LV Scar |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 35 | HC | 0 | — | — | + | 28.2 | 5 | 10/13/2011 | 435 | 6.0 | 1.0 | 0 | — | 0 |
| 2 | 46 | IDC | 0 | — | — | + | 29.9 | 15 | 12/23/2001 | 565 | 5.0 | 2.5 | 0 | — | 0 |
| 3 | 47 ⁎ | IDC | 0 | — | — | + | 30.3 | 10 | 4/25/2001 | 705 | 5.0 | 3.0 | 0 | — | 0 |
| 4 | 60 | IC | 0 | — | — | 0 | 27.5 | 7 | 7/1/2011 | 635 | 8.0 | 5.0 | + | 2005 | + |
| 5 | 30 | AS | + (SJM) | 1991 | 8 | 0 | 25.0 | 10 | 10/14/1999 | 650 | 5.5 | 2.8 | 0 | — | + |
| 6 | 56 | AS | + (Bio) | 2002 | 4.7 | + | 28.3 | 5 | 7/1/2007 | 730 | 6.0 | 4.0 | 0 | — | 0 |
| 7 | 65 | AS | + (SJM) | 1997 | 5.2 | 0 | 18.4 | 20 | 1/16/2003 | 615 | 7.5 | 3.0 | + | 1997 | + |
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