Bicuspid aortic valve ( BAV) is one of the most common congenital heart defects with a population prevalence of 0.5– 1.3% [1,2]. BAV has been id entifi ed as the main cause of aortic valve disease leading to surgical treatment in children and young adults. A large pathological survey revealed that BAV could result in a stenotic lesion in 75% of patients and insuffi ciency in 15% [3]. In the aspects of anatomy, compared to a normal tricuspid aortic valve (TAV), a BAV is formed with only two as a result of the fusion of two leafl ets into a larger one. Although BAV is often considered to be a benign lesion early in life, the complications associated with cardiovascular diseases, including aortic stenosis (AS), aortic insuffi ciency (AI), infective endocarditis (IE), and aortic dilation and dissection, can result in marked increases in morbidity and mortality later in life [3–5]. There have been many surgical techniques and different therapeutic options for patients presenting with BAV stenosis with or without regurgitation [6]. In clinical pract ice, at least 30% of patients with severe symptomatic aortic stenosis do not undergo surgery for replacement of the aortic valve, owing to advanced age, left ventricular dysfunction, or the presence of multiple coexisting conditions [7,8]. With the advent of transcatheter valves specifi cally for minimally invasive implantation procedures, AS patients at high risk with conventional surgery have benefi ted with transcatheter aortic valve implantation (TAVI). Nevertheless, BAV is generally considered to contraindicate TAVI in most randomized controlled trials [8,9], because of the poor stability of the prosthetic valve or paravalvular regurgitation due to non-ideal expansion of a valve in elliptical and calcifi ed annulus. Not only may the nonstandard shape and geometry of bicuspid valves predispose backfl ow leak during ventricular diastole after TAVI, but also the asymmetric dilatation resulting with irregular distribution of calcium deposits on the annulus of the BAV increase the risk of incomplete sealing, severe paravalvular leak and aortic regurgitation (AR), the complications which already exists as the major drawback of TAVI technology [10,11]. Here, we detailed a case of successful trans-femoral TAVI in a 77-year-old male with BAV.

Department of Cardiology Zhongda Hospital and School of Clinical Medicine Southeast University Nanjing Chin

Department of Cardiology Zhongda Hospital and School of Clinical Medicine Southeast University Nanjing China

Transcatheter aortic valve implantation in patients with bicuspid aortic valve

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