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In this next video, I wanna discuss bicuspid valves.

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So it turns out for bicuspid valves in tavr, these patients, um,

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have similar long-term outcomes to patients with the normal tricuspid

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valve. However, they do have a higher rate of paravalvular regurgitation. Um,

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and so for that reason, we really wanna know, uh,

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about these patients who have bicuspid valves ahead of time. And if we see it,

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we should certainly report it, um, to the interventionalists. Uh,

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on the right hand side, this figure you see, um,

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this is actually telling us about the rate of, um,

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paravalvular leak in patients with. Um,

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it's divided up into early and next gen devices. Um,

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but basically you see that for both the early devices and the more recent

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devices, the rate of paravalvular leak is always higher with patients with, uh,

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bicuspid aortic valve compared to those with a tricuspid, uh, aortic valve.

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So for that reason, it's important we, uh, reported.

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And also it's important to give some information about the type of bicuspid

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aortic valve. And there's really two major types, um,

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that you're gonna run into. This is a really nice review that came out, uh,

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back in 2021.

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It's a consensus statement on nomenclature and classifications of bicuspid

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aortic valves. And it turns out, you know, if, if you look into this, there,

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there are all sorts of different systems that have been developed for describing

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the aortic valves. Um,

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and different ones are used by different people and they're a little bit

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confusing with a lot of overlap. So this was a really nice paper that came out,

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uh,

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to basically come up with a consensus among imagers for how to describe these,

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um, aortic valves. And it's been approved by all the various big societies.

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Um, so what they came up with was that there are three major types of subgroups.

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Um,

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the largest 99 to 95% of patients being the fused by cuspid aortic

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valve. And those cases, um,

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they can actually be a little bit confusing because if you look at 'em,

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you'll see three aortic sinuses and cupps. However,

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two of them are stuck together and a lot of times they'll have what's called a

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RAF or a ridge between the two. Um, and that ridge, um,

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is often thickened and calcified in in most of these patients.

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The confusing part of this is if you're looking in diastole when the valve isn't

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open, you'll see three cusps, you'll see the RA or the ridge,

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which makes it look like there may be two separate cusp there.

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And you might not even realize that you're dealing with a bicuspid valve until

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you see the opening when it opens.

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It should have that same typical fish mouth opening that you see with any type

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of bicuspid valve because of the fusion of those, those two cusps.

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Now the other one which is less common is the two sinus bicuspid aortic valve.

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And this is actually the one that we think of traditionally as like,

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this is our sort of mental picture, at least for me, of what an aortic valve,

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a bicuspid aric valve looks like.

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And that's where you have only two sinuses and two cusps. And you know,

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it's obviously very obvious to figure out when you see these valves.

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And then the last category, which has a little question mark here because it

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Hasn't been well studied,

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is when you basically have incomplete fusion of two over the cusps and they call

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it partial fusion b a V. Um,

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the thought here is that this may be some sort of degenerative process where

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there have been some calcification and thickening of the leaflets that that lead

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to some partial fusion. So it's not completely a bi spiric valve,

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but somewhere in between. So just here some figures to show you this.

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Um, and this is actually referring back to that, um, guideline from, uh,

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J C C T A guideline on tavr, um, CT reporting. Um,

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and this guideline actually tells us a little bit about some of the other, uh,

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nomenclature that's used. So, um, this is the two sinus B a v, um,

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that we just talked about. Um,

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also referred to as a SEAVERS type zero or you might hear biral

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non RA type. It's all the same thing. And then on the bottom,

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this is the one that's the fused. Um, so that's known as seavers type one.

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And you can see here we've got a right uh,

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leaflet and a left leaflet and then this big calcified ridge here.

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And the opening is just from here to here. This does not open it's fused.

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So this is again, the most common type. Um, and that's known as, um, uh,

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fused b a v, again, seavers type one, uh, or bi commissural, Rafa type.

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So these are,

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I put these in here just 'cause they're all different terms that you may see

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thrown around in the chart, for instance,

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for the patient and that sort of thing. So I just wanna make sure, you know, um,

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you're prepared to, to see all those different, different names and,

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and understand what they mean. Lastly,

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we're gonna go through some actual images themselves, but this is a, um,

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just some video clips of these two different versions.

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So on the left hand side we have the, the fused.

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So you can see that the right and left cusp are fused here.

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There's no opening between the two. This is the ra,

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not really thickened or calcified, maybe just a little bit of calcification. Um,

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but you can see that that fish mouth opening and then this is the two cusp kind,

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kind of the traditional only two cusp are visible. Um, more rare, um,

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but certainly we encounter it, uh, from time to time.