{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T02:45:29Z","timestamp":1791945929740,"version":"4.3.4"},"reference-count":40,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"21","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2008,5,27]]},"abstract":"<jats:p>\n                    <jats:bold>\n                      <jats:italic>Background\u2014<\/jats:italic>\n                    <\/jats:bold>\n                    Bicuspid aortic valve is frequent and is reported to cause numerous complications, but the clinical outcome of patients diagnosed with normal or mildly dysfunctional valve is undefined.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>\n                      <jats:italic>Methods and Results\u2014<\/jats:italic>\n                    <\/jats:bold>\n                    In 212 asymptomatic community residents from Olmsted County, Minn (age, 32\u00b120 years; 65% male), bicuspid aortic valve was diagnosed between 1980 and 1999 with ejection fraction \u226550% and aortic regurgitation or stenosis, absent or mild. Aortic valve degeneration at diagnosis was scored echocardiographically for calcification, thickening, and mobility reduction (0 to 3 each), with scores ranging from 0 to 9. At diagnosis, ejection fraction was 63\u00b15% and left ventricular diameter was 48\u00b19 mm. Survival 20 years after diagnosis was 90\u00b13%, identical to the general population (\n                    <jats:italic>P<\/jats:italic>\n                    =0.72). Twenty years after diagnosis, heart failure, new cardiac symptoms, and cardiovascular medical events occurred in 7\u00b12%, 26\u00b14%, and 33\u00b15%, respectively. Twenty years after diagnosis, aortic valve surgery, ascending aortic surgery, or any cardiovascular surgery was required in 24\u00b14%, 5\u00b12%, and 27\u00b14% at a younger age than the general population (\n                    <jats:italic>P<\/jats:italic>\n                    &lt;0.0001). No aortic dissection occurred. Thus, cardiovascular medical or surgical events occurred in 42\u00b15% 20 years after diagnosis. Independent predictors of cardiovascular events were age \u226550 years (risk ratio, 3.0; 95% confidence interval, 1.5 to 5.7;\n                    <jats:italic>P<\/jats:italic>\n                    &lt;0.01) and valve degeneration at diagnosis (risk ratio, 2.4; 95% confidence interval, 1.2 to 4.5;\n                    <jats:italic>P<\/jats:italic>\n                    =0.016; &gt;70% events at 20 years). Baseline ascending aorta \u226540 mm independently predicted surgery for aorta dilatation (risk ratio, 10.8; 95% confidence interval, 1.8 to 77.3;\n                    <jats:italic>P<\/jats:italic>\n                    &lt;0.01).\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>\n                      <jats:italic>Conclusions\u2014<\/jats:italic>\n                    <\/jats:bold>\n                    In the community, asymptomatic patients with bicuspid aortic valve and no or minimal hemodynamic abnormality enjoy excellent long-term survival but incur frequent cardiovascular events, particularly with progressive valve dysfunction. Echocardiographic valve degeneration at diagnosis separates higher-risk patients who require regular assessment from lower-risk patients who require only episodic follow-up.\n                  <\/jats:p>","DOI":"10.1161\/circulationaha.107.740878","type":"journal-article","created":{"date-parts":[[2008,5,27]],"date-time":"2008-05-27T21:29:11Z","timestamp":1211923751000},"page":"2776-2784","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":520,"title":["Natural History of Asymptomatic Patients With Normally Functioning or Minimally Dysfunctional Bicuspid Aortic Valve in the Community"],"prefix":"10.1161","volume":"117","author":[{"given":"Hector I.","family":"Michelena","sequence":"first","affiliation":[{"name":"From the Divisions of Cardiovascular Diseases (H.I.M., V.T.N., P.A.P., M.E.-S.) and Cardiothoracic Surgery (T.M.S.), Mayo Clinic, Rochester, Minn; Centre Hospitalier Pierre Le Gardeur, Lachenaie, Quebec, Canada (V.A.D.); La Timone Hospital, Marseille, France (J.-F.A.); University Hospital of Bologna, Bologna, Italy (A.R.); and Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Ariz (A.J.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerie A.","family":"Desjardins","sequence":"additional","affiliation":[{"name":"From the Divisions of Cardiovascular Diseases (H.I.M., V.T.N., P.A.P., M.E.-S.) and Cardiothoracic Surgery (T.M.S.), Mayo Clinic, Rochester, Minn; Centre Hospitalier Pierre Le Gardeur, Lachenaie, Quebec, Canada (V.A.D.); La Timone Hospital, Marseille, France (J.-F.A.); University Hospital of Bologna, Bologna, Italy (A.R.); and Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Ariz (A.J.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Franc\u0327ois","family":"Avierinos","sequence":"additional","affiliation":[{"name":"From the Divisions of Cardiovascular Diseases (H.I.M., V.T.N., P.A.P., M.E.-S.) and Cardiothoracic Surgery (T.M.S.), Mayo Clinic, Rochester, Minn; Centre Hospitalier Pierre Le Gardeur, Lachenaie, Quebec, Canada (V.A.D.); La Timone Hospital, Marseille, France (J.-F.A.); University Hospital of Bologna, Bologna, Italy (A.R.); and Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Ariz (A.J.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Russo","sequence":"additional","affiliation":[{"name":"From the Divisions of Cardiovascular Diseases (H.I.M., V.T.N., P.A.P., M.E.-S.) and Cardiothoracic Surgery (T.M.S.), Mayo Clinic, Rochester, Minn; Centre Hospitalier Pierre Le Gardeur, Lachenaie, Quebec, Canada (V.A.D.); La Timone Hospital, Marseille, France (J.-F.A.); University Hospital of Bologna, Bologna, Italy (A.R.); and Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Ariz (A.J.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vuyisile T.","family":"Nkomo","sequence":"additional","affiliation":[{"name":"From the Divisions of Cardiovascular Diseases (H.I.M., V.T.N., P.A.P., M.E.-S.) and Cardiothoracic Surgery (T.M.S.), Mayo Clinic, Rochester, Minn; Centre Hospitalier Pierre Le Gardeur, Lachenaie, Quebec, Canada (V.A.D.); La Timone Hospital, Marseille, France (J.-F.A.); University Hospital of Bologna, Bologna, Italy (A.R.); and Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Ariz (A.J.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thoralf M.","family":"Sundt","sequence":"additional","affiliation":[{"name":"From the Divisions of Cardiovascular Diseases (H.I.M., V.T.N., P.A.P., M.E.-S.) and Cardiothoracic Surgery (T.M.S.), Mayo Clinic, Rochester, Minn; Centre Hospitalier Pierre Le Gardeur, Lachenaie, Quebec, Canada (V.A.D.); La Timone Hospital, Marseille, France (J.-F.A.); University Hospital of Bologna, Bologna, Italy (A.R.); and Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Ariz (A.J.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia A.","family":"Pellikka","sequence":"additional","affiliation":[{"name":"From the Divisions of Cardiovascular Diseases (H.I.M., V.T.N., P.A.P., M.E.-S.) and Cardiothoracic Surgery (T.M.S.), Mayo Clinic, Rochester, Minn; Centre Hospitalier Pierre Le Gardeur, Lachenaie, Quebec, Canada (V.A.D.); La Timone Hospital, Marseille, France (J.-F.A.); University Hospital of Bologna, Bologna, Italy (A.R.); and Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Ariz (A.J.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. 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