Skip to main content
Top
Published in: Journal of Genetic Counseling 6/2016

01-12-2016 | Review Paper

Bicuspid Aortic Valve: a Review with Recommendations for Genetic Counseling

Authors: Samantha L. Freeze, Benjamin J. Landis, Stephanie M. Ware, Benjamin M. Helm

Published in: Journal of Genetic Counseling | Issue 6/2016

Login to get access

Abstract

Bicuspid aortic valve (BAV) is the most common congenital heart defect and falls in the spectrum of left-sided heart defects, also known as left ventricular outflow tract obstructive (LVOTO) defects. BAV is often identified in otherwise healthy, asymptomatic individuals, but it is associated with serious long term health risks including progressive aortic valve disease (stenosis or regurgitation) and thoracic aortic aneurysm and dissection. BAV and other LVOTO defects have high heritability. Although recommendations for cardiac screening of BAV in at-risk relatives exist, there are no standard guidelines for providing genetic counseling to patients and families with BAV. This review describes current knowledge of BAV and associated aortopathy and provides guidance to genetic counselors involved in the care of patients and families with these malformations. The heritability of BAV and recommendations for screening are highlighted. While this review focuses specifically on BAV, the principles are applicable to counseling needs for other LVOTO defects.
Literature
go back to reference Ackerman, C., Locke, A. E, Feingold, E., Reshey, B., Espana, K., Thusberg, J., et al. (2012). An excess of deleterious variants in VEEGF-A pathway genes in Down-syndrome-associated atrioventricular septal defects. American Journal of Human Genetics, 91(4):646–59. Ackerman, C., Locke, A. E, Feingold, E., Reshey, B., Espana, K., Thusberg, J., et al. (2012). An excess of deleterious variants in VEEGF-A pathway genes in Down-syndrome-associated atrioventricular septal defects. American Journal of Human Genetics, 91(4):646–59.
go back to reference Angelini, A., Ho, S. Y., Anderson, R. H., Devine, W. A., Zuberbuhler, J. R., Becker, A. E., et al. (1989). The morphology of the normal aortic valve as compared with the aortic valve having two leaflets. The Journal of Thoracic and Cardiovascular Surgery, 98(3), 362–367. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/2770318 Angelini, A., Ho, S. Y., Anderson, R. H., Devine, W. A., Zuberbuhler, J. R., Becker, A. E., et al. (1989). The morphology of the normal aortic valve as compared with the aortic valve having two leaflets. The Journal of Thoracic and Cardiovascular Surgery, 98(3), 362–367. Retrieved from http://​www.​ncbi.​nlm.​nih.​gov/​pubmed/​2770318
go back to reference Arrington, C. B., Sower, C. T., Chuckwuk, N., Stevens, J., Leppert, M. F., Yetman, A. T., et al. (2008). Absence of TGFBR1 and TGFBR2 mutations in patients with bicuspid aortic valve and aortic dilation. The American Journal of Cardiology, 102(5), 629–631. doi:10.1016/j.amjcard.2008.04.044.CrossRefPubMed Arrington, C. B., Sower, C. T., Chuckwuk, N., Stevens, J., Leppert, M. F., Yetman, A. T., et al. (2008). Absence of TGFBR1 and TGFBR2 mutations in patients with bicuspid aortic valve and aortic dilation. The American Journal of Cardiology, 102(5), 629–631. doi:10.​1016/​j.​amjcard.​2008.​04.​044.CrossRefPubMed
go back to reference Bonachea, E. M., Change, S. W., Zender, G., LaHaye, S., Fitzgerald-Butt, S., McBride, K. L., et al. (2014). Rare GATA5 sequence variants identified in individuals with bicuspid aortic valve. Pediatric Research, 76(2), 211–216. doi:10.1038/pr.2014.67.CrossRefPubMed Bonachea, E. M., Change, S. W., Zender, G., LaHaye, S., Fitzgerald-Butt, S., McBride, K. L., et al. (2014). Rare GATA5 sequence variants identified in individuals with bicuspid aortic valve. Pediatric Research, 76(2), 211–216. doi:10.​1038/​pr.​2014.​67.CrossRefPubMed
go back to reference Davey, A., Rostant, K., Harrop, K., Goldblatt, J., & O'Leary, P. (2005). Evaluating genetic counseling: client expectations, psychological adjustment and satisfaction with service. Journal of Genetic Counseling, 14(3), 197–206. doi:10.1007/s10897-005-0519-6.CrossRefPubMed Davey, A., Rostant, K., Harrop, K., Goldblatt, J., & O'Leary, P. (2005). Evaluating genetic counseling: client expectations, psychological adjustment and satisfaction with service. Journal of Genetic Counseling, 14(3), 197–206. doi:10.​1007/​s10897-005-0519-6.CrossRefPubMed
go back to reference Davies, R. R., Kaple, R. K., Mandapati, D., Gallo, A., Botta Jr., D. M., Elefteriades, J. A., et al. (2007). Natural history of ascending aortic aneurysms in the setting of an unreplaced bicuspid aortic valve. The Annals of Thoracic Surgery, 83(4), 1338–1344. doi:10.1016/j.athoracsur.2006.10.074.CrossRefPubMed Davies, R. R., Kaple, R. K., Mandapati, D., Gallo, A., Botta Jr., D. M., Elefteriades, J. A., et al. (2007). Natural history of ascending aortic aneurysms in the setting of an unreplaced bicuspid aortic valve. The Annals of Thoracic Surgery, 83(4), 1338–1344. doi:10.​1016/​j.​athoracsur.​2006.​10.​074.CrossRefPubMed
go back to reference Della Corte, A., Bancone, C., Quarto, C., Dialetto, G., Covino, F. E., Scardone, M., et al. (2007). Predictors of ascending aortic dilatation with bicuspid aortic valve: a wide spectrum of disease expression. European Journal of Cardio-Thoracic Surgery, 31(3), 397–404. doi:10.1016/j.ejcts.2006.12.006.CrossRefPubMed Della Corte, A., Bancone, C., Quarto, C., Dialetto, G., Covino, F. E., Scardone, M., et al. (2007). Predictors of ascending aortic dilatation with bicuspid aortic valve: a wide spectrum of disease expression. European Journal of Cardio-Thoracic Surgery, 31(3), 397–404. doi:10.​1016/​j.​ejcts.​2006.​12.​006.CrossRefPubMed
go back to reference Gale, A. N., McKusick, V. A., Hutchins, G. M., & Gott, V. L. (1977). Familial congenital bicuspid aortic valve: secondary calcific aortic stenosis and aortic aneurysm. Chest, 72(5), 668–670.CrossRefPubMed Gale, A. N., McKusick, V. A., Hutchins, G. M., & Gott, V. L. (1977). Familial congenital bicuspid aortic valve: secondary calcific aortic stenosis and aortic aneurysm. Chest, 72(5), 668–670.CrossRefPubMed
go back to reference Godden, D. J., Sandhu, P. S., & Kerr, F. (1987). Stenosed bicuspid aortic valves in twins. European Heart Journal, 8, 316–318.PubMed Godden, D. J., Sandhu, P. S., & Kerr, F. (1987). Stenosed bicuspid aortic valves in twins. European Heart Journal, 8, 316–318.PubMed
go back to reference Guo, D. C., Pannu, H., Tran-Fadulu, V., Papke, C. L., Yu, R. K., Avidan, N., et al. (2007). Mutations in smooth muscle alpha-actin (ACTA2) lead to thoracic aortic aneurysms and dissections. Nature Genetics, 39(12), 1488–1493. doi:10.1038/ng.2007.6.CrossRefPubMed Guo, D. C., Pannu, H., Tran-Fadulu, V., Papke, C. L., Yu, R. K., Avidan, N., et al. (2007). Mutations in smooth muscle alpha-actin (ACTA2) lead to thoracic aortic aneurysms and dissections. Nature Genetics, 39(12), 1488–1493. doi:10.​1038/​ng.​2007.​6.CrossRefPubMed
go back to reference Hiratzka, L. F., Bakris, G. L., Beckman, J. A., Bersin, R. M., Carr, V. F., Casey Jr., D. E., et al. (2010). 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation, 121(13), e266–e369. doi:10.1161/CIR.0b013e3181d4739e.CrossRefPubMed Hiratzka, L. F., Bakris, G. L., Beckman, J. A., Bersin, R. M., Carr, V. F., Casey Jr., D. E., et al. (2010). 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation, 121(13), e266–e369. doi:10.​1161/​CIR.​0b013e3181d4739e​.CrossRefPubMed
go back to reference Hiratzka, L. F., Creager, M. A., Isselbacher, E. M., Svensson, L. G., Nishimura, R. A., Bonow, R. O., et al. (2016). Surgery for aortic dilatation in patients with bicuspid aortic valves: a statement of clarification from the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Journal of the American College of Cardiology, 67(6), 724–731. doi:10.1016/j.jacc.2015.11.006.CrossRefPubMed Hiratzka, L. F., Creager, M. A., Isselbacher, E. M., Svensson, L. G., Nishimura, R. A., Bonow, R. O., et al. (2016). Surgery for aortic dilatation in patients with bicuspid aortic valves: a statement of clarification from the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Journal of the American College of Cardiology, 67(6), 724–731. doi:10.​1016/​j.​jacc.​2015.​11.​006.CrossRefPubMed
go back to reference Kerstjens-Frederikse, W. S., Du Marchie, S. G. J., & Ruiter, J. S. (2011). Left ventricular outflow tract obstruction: should cardiac screening be offered to first-degree relatives? (vol 97, pg 1228, 2011). Heart, 97(19), 1626–1626. doi:10.1136/hrt.2010.211433corr1. Kerstjens-Frederikse, W. S., Du Marchie, S. G. J., & Ruiter, J. S. (2011). Left ventricular outflow tract obstruction: should cardiac screening be offered to first-degree relatives? (vol 97, pg 1228, 2011). Heart, 97(19), 1626–1626. doi:10.​1136/​hrt.​2010.​211433corr1.
go back to reference Kerstjens-Frederikse, W. S., van de Laar, I. M. B. H., Vos, Y. J., Verhagen, J. M. A., Berger, R. M. F., Lichtenbelt, K. D., et al. (2016). Cardiovascular malformations caused by NOTCH1 mutations do not keep left: data on 428 probands with left-sided CHD and their families. Genetics in Medicine. doi:10.1038/gim.2015.193.PubMed Kerstjens-Frederikse, W. S., van de Laar, I. M. B. H., Vos, Y. J., Verhagen, J. M. A., Berger, R. M. F., Lichtenbelt, K. D., et al. (2016). Cardiovascular malformations caused by NOTCH1 mutations do not keep left: data on 428 probands with left-sided CHD and their families. Genetics in Medicine. doi:10.​1038/​gim.​2015.​193.PubMed
go back to reference La Canna, G., Ficarra, E., Tsagalau, E., Nardi, M., Morandini, A., Chieffo, A., et al. (2006). Progression rate of ascending aortic dilation in patients with normally functioning bicuspid and tricuspid aortic valves. American Journal of Cardiology, 98(2), 249–253. doi:10.1016/j.amjcard.2006.01.096.CrossRefPubMed La Canna, G., Ficarra, E., Tsagalau, E., Nardi, M., Morandini, A., Chieffo, A., et al. (2006). Progression rate of ascending aortic dilation in patients with normally functioning bicuspid and tricuspid aortic valves. American Journal of Cardiology, 98(2), 249–253. doi:10.​1016/​j.​amjcard.​2006.​01.​096.CrossRefPubMed
go back to reference Lewin, M. B., McBride, K. L., Pignatelli, R., Fernbach, S., Combes, A., Menesses, A., et al. (2004). Echocardiographic evaluation of asymptomatic parental and sibling cardiovascular anomalies associated with congenital left ventricular outflow tract lesions. Pediatrics, 114(3), 691–696. doi:10.1542/peds.2003-0782-L.CrossRefPubMedPubMedCentral Lewin, M. B., McBride, K. L., Pignatelli, R., Fernbach, S., Combes, A., Menesses, A., et al. (2004). Echocardiographic evaluation of asymptomatic parental and sibling cardiovascular anomalies associated with congenital left ventricular outflow tract lesions. Pediatrics, 114(3), 691–696. doi:10.​1542/​peds.​2003-0782-L.CrossRefPubMedPubMedCentral
go back to reference Lindsay, M. E., Schepers, D., Bolar, N. A., Doyle, J. J., Gallo, E., Fert-Bober, J., et al. (2012). Loss-of-function mutations in TGFB2 cause a syndromic presentation of thoracic aortic aneurysm. Nature Genetics, 44(8), 922. doi:10.1038/ng.2349.CrossRefPubMedPubMedCentral Lindsay, M. E., Schepers, D., Bolar, N. A., Doyle, J. J., Gallo, E., Fert-Bober, J., et al. (2012). Loss-of-function mutations in TGFB2 cause a syndromic presentation of thoracic aortic aneurysm. Nature Genetics, 44(8), 922. doi:10.​1038/​ng.​2349.CrossRefPubMedPubMedCentral
go back to reference Loscalzo, M. L., Goh, D. L. M., Loeys, B., Kent, K. C., Spevak, P. J., & Dietz, H. C. (2007). Familial thoracic aortic dilation and bicommissural aortic valve: A prospective analysis of natural history and inheritance. American Journal of Medical Genetics Part A, 143a(17), 1960–1967. doi:10.1002/ajmg.a.31872.CrossRefPubMed Loscalzo, M. L., Goh, D. L. M., Loeys, B., Kent, K. C., Spevak, P. J., & Dietz, H. C. (2007). Familial thoracic aortic dilation and bicommissural aortic valve: A prospective analysis of natural history and inheritance. American Journal of Medical Genetics Part A, 143a(17), 1960–1967. doi:10.​1002/​ajmg.​a.​31872.CrossRefPubMed
go back to reference Martin, L. J., Ramachandran, V., Cripe, L. H., Hinton, R. B., Andelfinger, G., Tabangin, M., et al. (2007). Evidence in favor of linkage to human chromosomal regions 18q, 5q, and 13q for bicuspid aortic valve and associated cardiovascular malformations. Human Genetics, 121(2), 275–284.CrossRefPubMed Martin, L. J., Ramachandran, V., Cripe, L. H., Hinton, R. B., Andelfinger, G., Tabangin, M., et al. (2007). Evidence in favor of linkage to human chromosomal regions 18q, 5q, and 13q for bicuspid aortic valve and associated cardiovascular malformations. Human Genetics, 121(2), 275–284.CrossRefPubMed
go back to reference McBride, K. L., Pignatelli, R., Lewin, M., Ho, T., Fernbach, S., Menesses, A., et al. (2005). Inheritance analysis of congenital left ventricular outflow tract obstruction malformations: segregation, multiplex relative risk, and heritability. American Journal of Medical Genetics Part A, 134A(2), 180–186. doi:10.1002/ajmg.a.30602.CrossRefPubMed McBride, K. L., Pignatelli, R., Lewin, M., Ho, T., Fernbach, S., Menesses, A., et al. (2005). Inheritance analysis of congenital left ventricular outflow tract obstruction malformations: segregation, multiplex relative risk, and heritability. American Journal of Medical Genetics Part A, 134A(2), 180–186. doi:10.​1002/​ajmg.​a.​30602.CrossRefPubMed
go back to reference McKellar, S. H., Tester, D. J., Yagubyan, M., Majumdar, R., Ackerman, M. J., & Sundt, T. M. (2007). Novel NOTCH1 mutations in patients with bicuspid aortic valve disease and thoracic aortic aneurysms. The Journal of Thoracic and Cardiovascular Surgery, 134, 290–296. doi:10.1016/j.jtcvs.2007.02.041.CrossRefPubMed McKellar, S. H., Tester, D. J., Yagubyan, M., Majumdar, R., Ackerman, M. J., & Sundt, T. M. (2007). Novel NOTCH1 mutations in patients with bicuspid aortic valve disease and thoracic aortic aneurysms. The Journal of Thoracic and Cardiovascular Surgery, 134, 290–296. doi:10.​1016/​j.​jtcvs.​2007.​02.​041.CrossRefPubMed
go back to reference McKellar, S. H., MacDonald, R. J., Michelena, H. I., Connolly, H. M., & Sundt, T. M. 3rd. (2011). Frequency of cardiovascular events in women with a congenitally bicuspid aortic valve in a single community and effect of pregnancy on events. The American Journal of Cardiology, 107(1), 96–99. doi:10.1016/j.amjcard.2010.08.061. McKellar, S. H., MacDonald, R. J., Michelena, H. I., Connolly, H. M., & Sundt, T. M. 3rd. (2011). Frequency of cardiovascular events in women with a congenitally bicuspid aortic valve in a single community and effect of pregnancy on events. The American Journal of Cardiology, 107(1), 96–99. doi:10.​1016/​j.​amjcard.​2010.​08.​061.
go back to reference Mohamed, S. A., Aherrahrou, Z., Liptau, H., Erasmi, A. W., Hagemann, C., Wrobel, S., et al. (2006). Novel missense mutations (p.T596 M and p.P1797H) in NOTCH1 in patients with bicuspid aortic valve. Biochemical and Biophysical Research Communications, 345(4), 1460–1465. doi:10.1016/j.bbrc.2006.05.046.CrossRefPubMed Mohamed, S. A., Aherrahrou, Z., Liptau, H., Erasmi, A. W., Hagemann, C., Wrobel, S., et al. (2006). Novel missense mutations (p.T596 M and p.P1797H) in NOTCH1 in patients with bicuspid aortic valve. Biochemical and Biophysical Research Communications, 345(4), 1460–1465. doi:10.​1016/​j.​bbrc.​2006.​05.​046.CrossRefPubMed
go back to reference Nishimura, R. A., Otto, C. M., Bonow, R. O., Carabello, B. A., Erwin 3rd, J. P., Guyton, R. A., et al. (2014). 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. The Journal of Thoracic and Cardiovascular Surgery, 148(1), e1–e132. doi:10.1016/j.jtcvs.2014.05.014.CrossRefPubMed Nishimura, R. A., Otto, C. M., Bonow, R. O., Carabello, B. A., Erwin 3rd, J. P., Guyton, R. A., et al. (2014). 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. The Journal of Thoracic and Cardiovascular Surgery, 148(1), e1–e132. doi:10.​1016/​j.​jtcvs.​2014.​05.​014.CrossRefPubMed
go back to reference Proost, D., Vandeweyer, G., Meester, J. A. N., Salemink, S., Kempers, M., Ingram, C., et al. (2015). Performance mutation identification using targeted next-generation sequencing of 14 thoracic aortic aneurysm genes. Human Mutation, 36(8), 808–814. doi:10.1002/humu.22802.CrossRefPubMed Proost, D., Vandeweyer, G., Meester, J. A. N., Salemink, S., Kempers, M., Ingram, C., et al. (2015). Performance mutation identification using targeted next-generation sequencing of 14 thoracic aortic aneurysm genes. Human Mutation, 36(8), 808–814. doi:10.​1002/​humu.​22802.CrossRefPubMed
go back to reference Swain, S. (2011). Evaluation of Recurrence Risks for Left-Sided Cardiac Lesions. UT GSBS Dissertations and Theses (OpenAccess), Paper 152. Online: digitalcommons.library.tmc.edu/cgi/viewcontent.cgi?article = 1156&context = utgsbs_dissertations. Swain, S. (2011). Evaluation of Recurrence Risks for Left-Sided Cardiac Lesions. UT GSBS Dissertations and Theses (OpenAccess), Paper 152. Online: digitalcommons.library.tmc.edu/cgi/viewcontent.cgi?article = 1156&context = utgsbs_dissertations.
Metadata
Title
Bicuspid Aortic Valve: a Review with Recommendations for Genetic Counseling
Authors
Samantha L. Freeze
Benjamin J. Landis
Stephanie M. Ware
Benjamin M. Helm
Publication date
01-12-2016
Publisher
Springer US
Published in
Journal of Genetic Counseling / Issue 6/2016
Print ISSN: 1059-7700
Electronic ISSN: 1573-3599
DOI
https://doi.org/10.1007/s10897-016-0002-6

Other articles of this Issue 6/2016

Journal of Genetic Counseling 6/2016 Go to the issue