Bicuspid aortic valve phenotype relationship with aortic root morphology and elasticity (original) (raw)
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37.74 vs. 36.01, p = 0.031). Patients with CoA and type 1A BAV had significantly less valve regurgitation (13.6 vs. 55.8 %, p < 0.001) and smaller diameters of the ascending aorta (33.7 vs. 37.8 mm, p < 0.001) and aortic arch (25.8 vs. 30.2 mm, p < 0.001) than patients with isolated BAV. Conclusions Type 1A BAV with complete raphe is associated with more aortic regurgitation and root dilatation. The majority of CoA patients have incomplete raphes, associated with smaller aortic root diameters and less valve regurgitation.
Echocardiography, 2010
Background: Bicuspid aortic valve (BAV) is the leading cause of aortic stenosis in patients younger than the age of 50. A classification scheme of BAVs is based upon leaflet orientation: Type I (fusion of right and left coronary cusps) and Type II (fusion of right and noncoronary cusps). The correlation between BAV leaflet orientation and aortic root pathology however remains ill defined. Objective: The objective was to describe a potential relationship between BAV leaflet morphology and aortic root measurements in the ASTRONOMER study, a multicenter study to assess the effect of rosuvastatin on the progression of AS. Methods: BAV morphology was classified as Type I or Type II orientation based on the parasternal short-axis view. Echo measurements including left ventricular and aortic root dimensions were obtained. Results: The study population included 89 patients (56 ± 11 years; 44 males). There were 63 patients with Type I and 26 patients with Type II BAV. Baseline demographics, hemodynamics, and left heart dimensions were similar between both groups. Patients with Type I BAV had larger aortic annulus and ascending root dimensions compared to those patients with Type II BAV (P < 0.05). Conclusion: In patients with mild to moderate aortic stenosis due to a BAV, the presence of Type I valve orientation was associated with significantly greater aortic root parameters compared to Type II valve orientation.
World Journal of Cardiovascular Surgery, 2012
Objective: To find out, whether the degenerative process of ascending aorta is limited to the aortic sinuses only or is extending to mid and distal ascending aorta of Bicuspid Aortic Valve patients. Method: A prospective consecutive study on 25 patients of BAV (undergoing aortic valve with ±ascending aortic surgeries) was conducted from 1st Jan 2010 to 30th Dec 2011. Morphological and anatomical data of root and ascending aorta were recorded from echocardiography and computed tomography angiography. Intra-operatively, aortic tissue biopsy taken from three sites: sinus, mid, and distal ascending aorta. Histological evaluation of the aortic wall was based on criteria adapted from Schlatmann and Becker and from de Sa et al. The presence and degree of the 5 variables of degeneration were studied: Linear regression and correlation were used to get relationship between histopathological scoring (HPE-T) and aortic diameter for each site of ascending aorta. Results: Significant linear relation was found between aortic sinus diameter and HPE T score with R value = 0.590 (p value 0.001) and variance of 37.5%. Analysis suggests that HPE T Score = −5.139 + (0.188× Ao. Sinus Diameter in mm). No significant linear relation could be established between mid and distal ascending aorta diameter and HPE T scoring. Conclusion: In BAV patients, a definite relationship between degenerative changes of aortic media and aortic diameter was found and was limited up to the sinus level only. Thus, the study reinforces the thought of replacing aortic sinus too while dealing with aortic valve, even without significant dilatation. By this aggressive management of aortic root, progression of aortic dilatation or dissection can be prevented in bicuspid aortic valve patients.
International Journal of Cardiology, 2012
Background: Bicuspid aortic valve (BAV) represents the most common cardiac congenital malformation in the adult age. It is frequently associated with dilatation, aneurysm and dissection of the ascending aorta. The purpose of the following study was to evaluate in patients with BAV: 1) the elastic properties of the ascending aorta, 2) the mechanical function of the left ventricle and 3) stiffness, elasticity and strain of the epi-aortic vessels wall. Methods: Forty BAV patients (28 M/12 F; age 20.9 ± 4.7 years; range 17-26) with no or mild valvular impairment were recruited with 40 control subjects (25 M/15 F; age 23.4 ± 3.4 years; range 15-31) matched for age, gender and body surface area (BSA). Aortic strain, aortic distensibility (AoDIS) and aortic stiffness index (AoSI) were derived. Left ventricular strain was acquired. Elastic properties of epi-aortic vessels were evaluated. Results: BAVs vs. controls had increased systolic and diastolic aortic diameters (p b 0.001). Aortic strain (%) was lower in BAVs than in controls (8.3 ± 3.6 vs. 11.2 ± 2.6; p b 0.001) as well as AoDIS (10 − 6 cm 2 dyn − 1) (6.5 ± 2.8 vs. 8.8 ± 2.9; p = 0.002), while AoSI was greater in BAVs (6.4 ± 3.5 vs. 3.9 ± 1.2; p b 0.001). Both AoDIS and aortic strain were related to aortic size in BAVs and controls. Left ventricular longitudinal (p = 0.01), circumferential (p = 0.01) and radial (p b 0.001) strain (%) were lower in BAVs. No significant differences were found in elastic properties of epi-aortic vessels. Conclusions: Bicuspid aortic valve is associated with an increased aortic stiffness and with a reduction of the aortic and left ventricular deformation properties. Epi-aortic vessels do not seem to be interested by the disease. The use of an echocardiographic method that can estimate the degree of aortic and left ventricular remodeling can provide great benefits in the selection of patients with BAV to be treated and in determining the time for beginning drug therapy.
Turk Kardiyoloji Dernegi Arsivi-Archives of the Turkish Society of Cardiology
We investigated the frequency of different bicuspid aortic valve disease (BAV) phenotypes,the associated valvular pathologies, and the aortopathy phenotypes, using 2-dimensional (2D) transthoracic, 2D transesophageal echocardiography (TEE) and 3-dimensional (3D) TEE. Methods: A total of 154 patients with BAV were included. Five BAV phenotypes were detected. To better define valvular pathologies, binary classifications of BAV were used: BAV with antero-posterior commisural line (BAV-AP) and right-left commissural line (BAV-RL). Aortopathy phenotype was classified according to the involved tract(s). Results: Of the patients, 53.2% had type 1, 16.2% type 2, 15.6% type 3, 1.3% type 4, and 13.6% had type 5 BAV. The prevalence of BAV-AP and BAV-RL was 68.2% and 31.8%, respectively. No difference was detected with respect to aortic regurgitation between BAV-AP and BAV-RL (p=0.9), but the BAV-RL group had an increased propensity to have a stenotic aortic valve (p=0.003). The indexed aortic diameter was larger in BAV-AP cases than BAV-RL at the sinus of Valsalva (p=0.008). In patients with dilatation of the root and tubular portion, a predominance of BAV-AP versus BAV-RL was observed (85% vs 15%). A markedly low prevalence of the root phenotype (3.2%) was observed. In 90.1% of the patients, 2D TEE was sufficient to classify BAV phenotypes; further 3D imaging was needed in 9.9% of the cases. Conclusion: There may be racial differences in the frequency of valvular and aortopathy phenotypes in patients with BAV. BAV phenotypes differ with respect to aortic stenosis and aortopathy phenotypes. TEE may have good diagnostic utility in differentiating BAV phenotypes. Amaç: Farklı biküspit aort kapak (BAK) fenotiplerinin dağılımını, kapak patolojilerini ve aortopati fenotiplerininin dağılımını iki boyutlu (2B) transtorasik, 2B transözofajiyal ekokardiyografi (TÖE) ve 3B TÖE kullanarak araştırdık ve de bu incelemelerin BAK fenotiplendirmesinde kullanım yerini değerlendirdik. Yöntemler: BAK'lı 154 hasta çalışmaya alındı. Beş BAK fenotipi saptandı. Kapak patolojilerini daha iyi tanımlamak için ikili BAK sınıflandırması şu şekilde kullanıldı: Ön-arka komissür çizgisinin olduğu BAK-ÖA ve sağ-sol komissür çizgisinin olduğu BAV-SS. Aortopati fenotipleri tutulum olan kısımlara göre sınıflandırıldı. Bulgular: Hastaların %53.2'sinde tip 1, %16.2'sinde tip 2, %15.6'sında tip 3, %1.3'ünde tip 4 ve %13.6'sında tip 5 BAK alt tipi saptandı. BAK-ÖA ve BAK-SS'nin prevalansı sırasıyla %68.2 ve %31.8 idi. BAK-ÖA ve BAK-SS, kapak patolojileri açısından karşılaştırıldığında aort yetersizliği açısından fark yokken (p=0.9), BAK-SS grubunda daralmış bir kapak bulundurma eğilimi daha yüksekti (p=0.003). Sinüsler düzeyinde endekslenmiş aort çapı BAK-ÖA'da BAK-SS'ye göre daha genişti (p=0.008). Kök ve tübüler bölümün genişlediği hastalarda BAK-ÖA saptanma sıklığı BAK-SS saptanma sıklığına göre daha yüksekti (%85'e karşı %15). BAK popülasyonumuzda kök fenotipi (%3.2) belirgin olarak azdı. 2B TÖE hastaların %90.1'inde BAK fenotipini belirleyebildi ve 3B görüntülemeye olguların %9.9'unda ihtiyaç duyuldu. Sonuç: BAK'lı hastalarda kapak ve aortopati fenotiplerinin sıklığında ırksal değişiklikler olabilir. BAK fenotipleri aort darlığı ve aortopati açısından farklılıklar göstermektedir. BAK fenotipini belirlemede TTE'nin düşük yararına karşın TÖE iyi bir tanısal fayda sağlayabilir.