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Unicuspid aortic valve (UAV) is a rare disease usually diagnosed at surgical inspection or with echocardiography. However, it is often difficult to distinguish a true UAV from a calcified bicuspid aortic valve (BAV) by echocardiography and even by direct surgical inspection. This study assessed the accuracy of surgical inspection and two-dimensional echocardiography in diagnosing UAV.
The institutional echocardiographic database, anatomic pathology database and electronic medical record were searched for all patients with a diagnosis of UAV. Transthoracic (TTE), transesophageal (TEE) echocardiographic diagnosis and surgical diagnosis were compared to pathological diagnosis as the gold standard.
379 patients were identified with UAV by one or more method, and 230 had a pathologically confirmed diagnosis. For diagnosing UAV, the sensitivity and specificity were 15% and 87% for TTE, 25% and 82% for TEE, and 52% and 50% for surgical inspection, respectively. The positive and negative predictive values were 36% and 67% for TTE, 35% and 74% for TEE, and 29% and 73% for surgical inspection, respectively.
Surgical inspection is neither sensitive nor specific in diagnosing UAV. Much of the current literature regarding UAV is based on surgical inspection for diagnosis. The lack of diagnostic accuracy demonstrated in this study suggests that the current understanding of the natural history of UAV is likely inaccurate due to the accidental inclusion of BAVs.
Poster Hall, Hall A/B
Saturday, March 10, 2018, 10:00 a.m.-10:45 a.m.
Session Title: All Things Aortic!
Abstract Category: 09. Congenital Heart Disease: Adult
Presentation Number: 1123-357
- 2018 American College of Cardiology Foundation