Valva aórtica bivalvular... Dia desses me deparei com uma dúvida: existe diferença na evolução da disfunção valvar levando-se em conta a orientação espacial da abertura valvar? Quero dizer, com relação a disposição das válvulas: ântero-posterior ou direita-esquerda?
Vejam esses 2 casos:
"Fusion of the right and left coronary cusps is associated with coarctation of the aorta. Fusion of the right and noncoronary cusps is associated with cuspal pathology."Journal of the American College of Cardiology Vol. 55, No. 25, 2010
A Larger Aortic Annulus Causes Aortic Regurgitation and a Smaller Aortic Annulus Causes Aortic Stenosis in Bicuspid Aortic Valve
A bicuspid aortic valve (BAV) often causes aortic stenosis (AS) or regurgitation (AR). In 54 patients with a BA (48± 16 years), transthoracic and transesophageal echo were performed to measure aortic annulus diameter (AAD), to evaluate the severity of aortic valve disease (AVD) and to calculate the area eccentricity index (AEI) of a BAV defined as a ratio of the larger aortic cusp area to a smaller aortic cusp area. By multiple linear regression analysis, the severity of AR correlated significantly with the AAD (r = 0.38) and AEI (r = 0.35) (P < 0.05) and that of AS correlated significantly with the AAD (r = −0.40) and AEI (r = 0.34) (P < 0.05). Thirty-six patients showed anteroposteriorly (A-P) located BAVs and 18 patients showed right-left (R-L) located BAVs. The AAD was larger in A-P type than in R-L type (15 ± 3 vs 13 ± 2 mm/BSA, P < 0.05) and there was no difference in the age and AEI between the two groups. AR was more severe in A-P type than in R-L type while AS was more severe in R-L type than in A-P type (P< 0.05). Twenty-nine patients showed raphes. The AEI was larger in raphe (+) type than in raphe (–) type (1.83 ± 0.53 vs 1.51 ± 0.47, P < 0.05) and there was no difference in the AAD and severity of AVD between the two groups. In conclusion, a BAV with larger aortic annulus or A-P located will tend to cause AR while a BAV with smaller aortic annulus or R-L located will tend to cause AS. (ECHOCARDIOGRAPHY, Volume 25, March 2008