Diagnosis and Therapeutic Cardiac Catheterization of Symptomatic Bicuspid Aortic Stenosis in the Pediatric Population

Figures

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  Figure 1. BAV morphology: (1) Type 1 BAV with complete raphe and asymmetrical as the noncoronary is smaller than the conjoined cusp. (2) Type 2 BAV with complete raphe and asymmetrical as the left cusp is larger than the conjoined cusp. (3) Type 3 BAV with complete raphe and asymmetrical as the right cusp is larger than the conjoined cusp. (4) Type 1 BAV but with complete raphe but symmetrical cusps size. (5) Type 1 BAV but with no raphe and symmetrical cusps size. (6) Type 1 BAV but with incomplete raphe and partially fused left and right cusps. L: Left cusp, N: Noncoronary cusp, R: Right cusp, BAV: Bicuspid aortic valve

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  Figure 2. The parasternal long-axis view showing asymmetric diastolic leaflet closure line and dilated ascending aorta

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  Figure 3. The parasternal short-axis view showing two commissures in systole

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  Figure 4. Transaortic pressure gradient: Pressure waveforms obtained through simultaneous pressure measurement in the LV and RFA. The peak-to-peak gradient here is 62 mmHg. LV: left ventricle. RFA: right femoral artery

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  Figure 5. Ventriculography: Left ventriculography in a 5-year-old girl with BAV and severe AS in systole and diastole. One can appreciate the narrowed aortic valve orifice and the restricted leaflet opening [Video 1]. BAV: Bicuspid aortic valve, AS: Aortic valve stenosis

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  Figure 6. BVP: Cine image of the same child in Figure 5. Balloon positioned across the aortic valve over an exchange length guidewire. The balloon is inflated and the waist can be appreciated. Also, the temporary pacemaker catheter can be seen with the tip in the right ventricle [Video 2]

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  Figure 7. Aortography post-BVP: Aortography of the same child in Figures 5 and 6, which shows mild aortic regurgitation postintervention