Downsizing strategy (selecting one size smaller valve than annular measurement) reduces annular rupture and pacemaker rates without increasing moderate-to-severe paravalvular leak at one year in bicuspid aortic valve patients compared to standard annular sizing.
Cardiovascular CT is an essential imaging modality for the diagnosis, procedural planning (such as TAVR sizing), and post-procedural monitoring of bicuspid aortic valve disease.
Bicuspid Aortic Valve (BAV) disease is recognized as the most common congenital heart condition and is frequently associated with complex valvular and aortic disorders. Cardiovascular computed tomography (CT) has become essential for diagnosing BAV, planning procedures, and evaluating patients after treatment. This is largely due to CT’s high spatial resolution and its ability to perform volume imaging effectively. This review provides an up-to-date overview of the increasing role of cardiovascular CT in the management of bicuspid aortic valve (BAV). It covers various aspects, including BAV morphology, optimal sizing for transcatheter aortic valve replacement (TAVR), and post-procedural monitoring. We highlight significant innovations, such as supra-annular sizing techniques and artificial intelligence (AI)-guided analysis, that position CT at the nexus of anatomy, function, and targeted treatment. Additionally, we address controversies concerning inconsistencies in sizing algorithms, recent classification challenges, and radiation exposure. Future development areas include AI predictive tools, radiomic phenotyping, and CT-guided precision medicine. This synthesis aims to provide clinicians and researchers with a high-level guide to the clinical integration of cardiovascular CT and its future in the BAV population. This review provides the most current, comprehensive synthesis on the pivotal role of cardiovascular CT in BAV management, offering a roadmap for integrating advanced imaging into clinical practice and guiding future research priorities.
Jawed et al. (Thu,) conducted a review in Patients with bicuspid aortic valve disease undergoing imaging and intervention planning. Cardiovascular computed tomography (CT) sizing strategies for TAVR in BAV vs. Annular sizing vs supra-annular sizing and Downsizing strategy was evaluated on One-year clinical outcomes including device success, paravalvular leak (PVL), mortality, and need for permanent pacemaker placement. Downsizing strategy (selecting one size smaller valve than annular measurement) reduces annular rupture and pacemaker rates without increasing moderate-to-severe paravalvular leak at one year in bicuspid aortic valve patients compared to standard annular sizing.