A Bicuspid Pulmonary Valve Associated with Tetralogy of Fallot

Nair, Vidhya; Thangaroopan, Molly; Cunningham, Kristopher S.; Mohammed, Sheeja B.; Siu, Samuel C.; Williams, William G.; Butany, Jagdish

doi:10.1111/j.1540-8191.2006.00208.x

Cited by 9 publications

(5 citation statements)

References 8 publications

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“…The true incidence of bicuspid pulmonary valve could be underestimated owing to difficulty in visualising the pulmonary valve on conventional two-dimensional echocardiography. Improper fusion or dedifferentiation of the endocardial cushion is responsible for abnormal semilunar valves and so a bicuspid pulmonary valve is more often associated with other congenital abnormalities such as tetralogy of Fallot or ventricular septal defect ( 2 ). As most patients with bicuspid pulmonary valves are asymptomatic, the diagnosis is often made incidentally after suspicious auscultatory findings and subsequent imaging.…”

Section: Discussionmentioning

confidence: 99%

A case of isolated bicuspid pulmonary valve

2018

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Our case highlights the finding of an abnormal pulmonary valve on 2D echocardiography, confirmed to be of bicuspid morphology with 3D imaging. The use of biplane imaging both in transthoracic and transoesophageal echocardiography and routine use of three-dimensional views particularly in transoesophageal echocardiography are of incremental value in better delineating pulmonary valve anatomy.Learning points:Bicuspid pulmonary valve as an isolated clinical entity is a rare finding in clinical practice with an incidence of about 0.1%.The true prevalence of the condition may be underestimated because of difficulty in visualising the pulmonary valve en-face on standard two-dimensional echocardiography.Trans-oesophageal echocardiography may provide better visualization of the pulmonary valve when transthoracic images are affected by interference from the left lung.Routine use of 3D echocardiography with biplane and zoomed views should be advocated for a full morphological assessment of the pulmonary valve, whether imaging via the transthoracic or transoesophageal approach.

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Section: Discussionmentioning

confidence: 99%

A case of isolated bicuspid pulmonary valve

2018

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“…Previous studies have documented that BPV were common in TOF patients [Nair, Thangaroopan, Cunningham et al (2006);McAleer, Kort, Rosenzweig et al (2001); Chacko, Chiramel, Vimala et al 2017]. Their data reported that 81% of bicuspid valves did not have a median raphe [Chacko, Chiramel, Vimala et al (2017)].…”

Section: The Leaflets Of Pvmentioning

confidence: 98%

“…Its morphologic feature is the presence of only two pulmonary leaflets instead of the normal tri-leaflet. Congenitally BPV are uncommon and the occurrence is often associated with tetralogy of Fallot (TOF) [Nair, Thangaroopan, Cunningham et al (2006);McAleer, Kurt, Rosenzweig et al (2001)]. In the reports by Winn et al [Winn and Hutchins (1973)] and Rao et al [Rao, Anderson and Edwards (1971)].…”

Section: Introductionmentioning

confidence: 99%

Computational Modeling of Human Bicuspid Pulmonary Valve Dynamic Deformation in Patients with Tetralogy of Fallot

Li¹,

Baird²,

Yao³

et al. 2019

Computer Modeling in Engineering &Amp; Sciences

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Pulmonary valve stenosis (PVS) is one common right ventricular outflow tract obstruction problem in patients with tetralogy of Fallot (TOF). Congenital bicuspid pulmonary valve (BPV) is a condition of valvular stenosis, and the occurrence of congenital BPV is often associated with TOF. Dynamic computational models of normal pulmonary root (PR) with tri-leaflet and PR with BPV in patients with TOF were developed to investigate the effect of geometric structure of BPV on valve stress and strain distributions. The pulmonary root geometry included valvular leaflets, sinuses, interleaflet triangles and annulus. Mechanical properties of pulmonary valve leaflet were obtained from biaxial testing of human PV leaflet, and characterized by an anisotropic Mooney-Rivlin model. The complete cardiac cycle was simulated to observe valve leaflet dynamic stress/strain behaviors. Our results indicated that stress/strain distribution patterns of normal tri-leaflet pulmonary valve (TPV) and the BPV were different on valve leaflets when the valve was fully open, but they were similar when valves were completely closed. When the valve was fully open, the BPV maximum stress value on the leaflets was 197.2 kPa, which was 94.3% higher than of the normal TPV value (101.5 kPa). During the valve was fully open, the stress distribution in the interleaflet triangles region of the PR was asymmetric in the BPV model compared with that in the TPV model. The geometric orifice area value in the completely opened position of BPV model was reduced 55.6 % from that of the normal PV. Our initial results demonstrated that valve geometrical variations with BPV may be a potential risk factor linked to occurrence of PVS in patients with TOF. Computational models could be a useful tool in identifying possible linkage between valve disease development and biomechanical factors. Large-scale clinical studies are needed to validate these preliminary findings.

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“…BPV is a very rare congenital abnormality usually associated with other congenital heart diseases such as tetralogy of Fallot, pulmonary stenosis, and transposition of the great vessels. 1) Interestingly, this case is the BPV accompanied by ASD. Generally, it's difficult or impossible to observe pulmonic valve directly in 2-dimensional TTE.…”

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confidence: 88%