title: Knowledge of native valve anatomy is essential in follow-up of patients after aortic valve replacement.
abstract: BACKGROUND
  After aortic valve replacement (AVR), bicuspid aortic valve (BAV) patients continue to be at risk of aortic complications. Therefore, knowledge of native valve anatomy is important for follow-up. We aimed to determine the extent of which the presence of BAV disease is known in a regional post-AVR population.
  
  
  METHODS
  The Electronical Medical Record system was used to collect all patients under follow-up after AVR. We documented their clinical data and used the operative report to determine valve phenotype; lacking reports were retrieved.
  
  
  RESULTS
  We identified 560 patients who underwent AVR between 1971 and 2012, with a median of 6.2years follow-up postoperatively. Mean age at surgery was 66years (SD13.2years), and 319 patients (57%) were male. In 29 cases (5%), an operative report was not available and in 85 patients (16%) the report lacked a description of valve phenotype. In 446 patients, a surgeon's description of native valve was available: 299 patients (67%) had tricuspid aortic valve, 140 (31%) BAV, and 3 (1%) quadricuspid aortic valve. In 4 patients (1%) the description was non-conclusive. In 66/140 BAV patients the surgeon's diagnosis was not reported back to the referring cardiologist, which corresponded with 12% of all 560 AVR patients. Another 21% of these 560 lacked a clear description of native valve anatomy: no report, no native valve description or an unclear valve description.
  
  
  CONCLUSIONS
  Native valve anatomy was not known in one-third of AVR patients under follow-up, which included almost half of the BAV patients. This lack of knowledge withholds patients from appropriate ascending aorta surveillance.
authors.affiliation: Department of Cardiology, Gelre Hospital, Apeldoorn, Netherlands. Electronic address: l.cozijnsen@gelre.nl.
authors.forename: Luc
authors.initials: L
authors.lastname: Cozijnsen
authors.affiliation: Department of Epidemiology, Gelre Hospital, Apeldoorn, Netherlands.
authors.forename: Hester J
authors.initials: HJ
authors.lastname: van der Zaag-Loonen
authors.affiliation: Department of Paediatric Gastroenterology and Hepatology, Erasmus Medical Centre, Rotterdam, Netherlands.
authors.forename: Martinus A
authors.initials: MA
authors.lastname: Cozijnsen
authors.affiliation: Department of Cardiology, Gelre Hospital, Apeldoorn, Netherlands.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Braam
authors.affiliation: Department of Cardiothoracic surgery, St Antonius Hospital, Nieuwegein, Netherlands.
authors.forename: Robin H
authors.initials: RH
authors.lastname: Heijmen
authors.affiliation: Department of Cardiology, Academic Medical Centre, Amsterdam, Netherlands.
authors.forename: Barbara J M
authors.initials: BJ
authors.lastname: Mulder
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000601:surgery*; D000082882:Bicuspid Aortic Valve Disease; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000601:surgery; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
keywords: Aortic valve replacement; Bicuspid aortic valve; Native aortic valve anatomy