What are the next steps for a patient who missed their aortic bicuspid valve echocardiogram?

From the Guidelines

The patient who missed their aortic bicuspid valve echocardiogram should reschedule the appointment as soon as possible by contacting their cardiologist's office or the imaging facility directly. While waiting for the rescheduled echocardiogram, the patient should continue taking all prescribed medications without interruption, particularly any beta-blockers (such as metoprolol or atenolol) or blood pressure medications that help reduce stress on the aortic valve, as recommended by the 2014 AHA/ACC guideline for the management of patients with valvular heart disease 1. The patient should also monitor and report any new or worsening symptoms like chest pain, shortness of breath, dizziness, fainting, or heart palpitations to their healthcare provider immediately.

Regular follow-up imaging is crucial for patients with bicuspid aortic valves because this congenital condition can lead to complications such as aortic stenosis, regurgitation, or aortic enlargement over time, as noted in the 2017 recommendations on the echocardiographic assessment of aortic valve stenosis from the European Association of Cardiovascular Imaging and the American Society of Echocardiography 1. The echocardiogram provides essential information about valve function, blood flow patterns, and aortic dimensions that guides treatment decisions and helps determine appropriate intervals for future monitoring.

Some key points to consider in the management of patients with bicuspid aortic valves include:

• The importance of assessing the aortic root and ascending aorta for dilation, as recommended in the 2017 focused update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography 1
• The use of cardiac magnetic resonance imaging or cardiac computed tomography when morphology of the aortic root or ascending aorta cannot be assessed accurately by echocardiography, as suggested in the 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease 1
• The consideration of surgery in asymptomatic patients with severe aortic regurgitation and impaired left ventricular function, as outlined in the 2007 guidelines on the management of valvular heart disease from the European Society of Cardiology 1

Missing scheduled imaging may delay detection of progressive valve dysfunction or aortic dilation that could require intervention, highlighting the need for prompt rescheduling and adherence to recommended follow-up intervals.

From the Research

Next Steps for Missed Aortic Bicuspid Valve Echocardiogram

• The patient should reschedule the missed echocardiogram as soon as possible to monitor the progression of valve dysfunction and aortic dilation 2.
• According to guidelines, patients with bicuspid aortic valve should have regular follow-up with a cardiovascular specialist to monitor disease progression and guide intervention 3.
• The follow-up care may include:
  • Yearly surveillance transthoracic echocardiography for left ventricular function, jet velocity, gradient, and valve area 4.
  • Yearly clinical evaluation for change in symptom status or functional capacity 4.
  • Evaluation of the aorta with MRI or CT angiography at some point, as 50% of BAV patients have aortic root involvement 4.
• Patients with moderate-severe valvular or aortic pathology should be closely monitored, and surveillance imaging should be performed regularly 3.
• The choice of imaging modality (echocardiography, MRI, or CT angiography) depends on the individual patient's needs and the presence of aortic dilation or other complications 5, 4.

Importance of Regular Follow-up

• Regular follow-up is crucial to monitor the progression of valve dysfunction and aortic dilation in patients with bicuspid aortic valve 2, 3.
• Patients with bicuspid aortic valve are at increased risk of progressive valvulopathy and aortopathy, and regular follow-up can help identify potential complications early 6, 3.
• The goal of regular follow-up is to guide intervention and prevent complications, such as aortic dissection or rupture 6, 4.