When someone is found to have a bicuspid aortic valve (BAV) incidentally, it is important to thoroughly investigate the individual in order to assess their risk for complications and determine the best course of management.
The following steps and tests are typically recommended for the evaluation and management of BAV:
- Clinical examination: A thorough history and physical examination should be performed to assess the individual’s symptoms, risk factors, and overall cardiovascular health.
- Echocardiogram: This is a non-invasive test that uses high-frequency sound waves to create a moving image of the heart. It can provide detailed images of the heart’s structure and function, and can detect other associated congenital heart anomalies such as aortic stenosis, aortic regurgitation, coarctation of the aorta and patent ductus arteriosus.
- Magnetic Resonance Imaging (MRI) : MRI is a non-invasive test that uses a powerful magnetic field, radio waves, and a computer to produce detailed images of the heart and blood vessels. MRI is more accurate than echocardiogram in assessing the aorta and its branches, and it can detect CoA and PDA.
- Computed tomography (CT) scans: CT scans can be used to evaluate CoA and PDA in patients with BAV, CT scans are highly sensitive and accurate in detecting CoA and PDA, and they can provide detailed images of the heart and blood vessels.
- Cardiac catheterization: In some cases, cardiac catheterization may be performed to further evaluate the aortic valve and determine if surgery is needed.
- Genetic testing: BAV has a genetic component, genetic testing can help to identify other family members who may be at risk for BAV and other congenital heart disease.
- Follow-up: Regular follow-up is important to monitor the progression of the BAV and to detect any complications
For individuals with bicuspid aortic valve (BAV) who are at high risk for infective endocarditis (IE), it may be recommended that they take antibiotics prior to certain invasive procedures, including dental procedures.
The American Heart Association (AHA) and the American College of Cardiology (ACC) have guidelines for the management of infective endocarditis (IE) and the use of antibiotics prior to dental procedures.
The AHA guidelines currently recommend that antibiotic prophylaxis is not routinely recommended for most patients, including those with a bicuspid aortic valve, unless they are in the high-risk category such as those who have had a previous episode of IE, those with a prosthetic heart valve, certain types of congenital heart disease, or a history of certain cardiac procedures.
On the other hand, the ACC guidelines recommend that patients with a bicuspid aortic valve who are at high risk for IE should take antibiotics prior to certain invasive procedures, including dental procedures.
It’s important to note that the recommendations from both organizations are based on the best available evidence at the time of their publication, but the guidelines are subject to change as new evidence and recommendations become available. Additionally, the guidelines are intended as a general framework for clinical decision-making and may not apply to all patients in all situations. Therefore, it’s always best to consult with a healthcare professional to make an informed decision about the use of antibiotics in a specific patient, taking into account the individual’s specific medical history and condition.
In summary, for individuals with bicuspid aortic valve (BAV) who are at high risk for infective endocarditis (IE), it may be recommended that they take antibiotics prior to certain invasive procedures, including dental procedures. However, the decision to take antibiotics should be made on a case-by-case basis, taking into account the individual’s specific medical history and condition.
The European Society of Cardiology (ESC) and the Cardiac Society of Australia and New Zealand (CSANZ) also have guidelines for the management of infective endocarditis (IE) and the use of antibiotics prior to dental procedures.
The ESC guidelines currently recommend that prophylactic antibiotics are not recommended for patients with a bicuspid aortic valve. They recommend that only patients with a prosthetic heart valve, previous endocarditis, certain complex cyanotic congenital heart disease, or surgically constructed systemic-pulmonary shunts or conduits are at high risk for IE and should receive prophylactic antibiotics before dental procedures.
The CSANZ guidelines also recommend that prophylactic antibiotics are not recommended for patients with bicuspid aortic valve. They recommend that only patients with a prosthetic heart valve, previous endocarditis, certain complex cyanotic congenital heart disease, or surgically constructed systemic-pulmonary shunts or conduits are at high risk for IE and should receive prophylactic antibiotics before dental procedures.
It’s important to note that the guidelines from these organizations are based on the best available evidence at the time of their publication, but the guidelines are subject to change as new evidence and recommendations become available. Additionally, the guidelines are intended as a general framework for clinical decision-making and may not apply to all patients in all situations. Therefore, it’s always best to consult with a healthcare professional to make an informed decision about the use of antibiotics in a specific patient, taking into account the individual’s specific medical history and condition.
In summary, the European Society of Cardiology (ESC) and the Cardiac Society of Australia and New Zealand (CSANZ) also have guidelines for the management of infective endocarditis (IE) and the use of antibiotics prior to dental procedures, and both societies recommend that
