Bicuspid aortic valves and thoracic aortic aneurysms in patients with intracranial aneurysms (original) (raw)
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Prevalence of Intracranial Aneurysms in Patients with Aortic Aneurysms
American Journal of Neuroradiology
BACKGROUND AND PURPOSE: Previous studies have suggested an association between aortic aneurysms and intracranial aneurysms with a higher prevalence of intracranial aneurysms in patients with aortic aneurysms. The aims of the present study were to evaluate the incidence of intracranial aneurysms in a large cohort of patients with aortic aneurysms and to identify potential risk factors for intracranial aneurysms in this population. MATERIALS AND METHODS: We included all patients with aortic aneurysms (either abdominal and/or thoracic) who had available cerebral arterial imaging and were seen at our institution during a 15-year period. We identified patients with intracranial aneurysms. Patient demographics, comorbidities, and aortic aneurysm and intracranial aneurysm sizes and locations were analyzed. Univariate analysis was performed with a 2 test for categoric variables and a Student t test or ANOVA for continuous variables. RESULTS: A total of 1081 patients with aortic aneurysms were included. Of them, 440 (40.7%) had abdominal aortic aneurysms, 446 (41.3%) had thoracic aortic aneurysms, and 195 (18.0%) had both abdominal aortic and thoracic aortic aneurysms. The overall prevalence of associated intracranial aneurysms in patients with aortic aneurysms was 11.8% (128/1081), with 12.7% (56/440), 10.8% (48/446), and 12.3% (24/195), respectively, in patients with abdominal aortic aneurysms, thoracic aortic aneurysms, and both thoracic aortic aneurysms and abdominal aortic aneurysms. Female patients had a higher risk of associated intracranial aneurysms (OR ϭ 2.08; 95% CI, 1.49-3.03; P ϭ .0002). There was a slight association between abdominal aortic aneurysm size and the prevalence of intracranial aneurysms (OR ϭ 1.02; 95% CI, 1.01-1.03; P ϭ .045). There was no significant association between the locations of the aortic and intracranial aneurysms (P ϭ .93). CONCLUSIONS: The prevalence of intracranial aneurysms is high in patients with aortic aneurysms. Further studies examining the role and cost-effectiveness of intracranial aneurysm screening in patients are warranted. ABBREVIATIONS: AA ϭ aortic aneurysm; AAA ϭ abdominal aortic aneurysm; ADPKD ϭ autosomal dominant polycystic kidney disease; IA ϭ intracranial aneurysm; TAA ϭ thoracic aortic aneurysm
Bicuspid aortic valve disease and ascending aortic aneurysms: gaps in knowledge
Cardiology research and practice, 2012
The bicuspid aortic valve is the most common congenital cardiac anomaly in developed nations. The abnormal bicuspid morphology of the aortic valve results in valvular dysfunction and subsequent hemodynamic derangements. However, the clinical presentation of bicuspid aortic valve disease remains quite heterogeneous with patients presenting from infancy to late adulthood with variable degrees of valvular stenosis and insufficiency and associated abnormalities including aortic coarctation, hypoplastic left heart structures, and ascending aortic dilatation. Emerging evidence suggests that the heterogeneous presentation of bicuspid aortic valve phenotypes may be a more complex matter related to congenital, genetic, and/or connective tissue abnormalities. Optimal management of patients with BAV disease and associated ascending aortic aneurysms often requires a thoughtful approach, carefully assessing various risk factors of the aortic valve and the aorta and discerning individual indicati...
Cardiovascular Diagnosis and Therapy, 2017
Background: Transthoracic echocardiography (TTE) is the standard procedure to distinguish tricuspid aortic valve (TAV) from bicuspid aortic valve (BAV). Published studies assessed the accuracy of TTE for BAV under ideal conditions. Conversely, we aimed at assessing accuracy of TTE for BAV under routine conditions. Methods: This retrospective, cross-sectional study of 216 adults included 132 men aged 62±14 years. Of these, 108 had BAV and 108 were age-matched individuals with TAV. All diagnoses were confirmed at surgery. We assessed TTE in two patient groups. First, in the (I) group of all 216 individuals, where we assessed accuracy for BAV according to the original diagnoses as documented by the primary investigators during original TTE examination. Second, we assessed accuracy for BAV according to expert re-evaluation in (II) all 158 TTE with availability of original recordings. Third, we performed a meta-analysis of published results on the accuracy of TTE for BAV according to PRISMA standards. Results: Sensitivity, specificity and accuracy of (I) primary investigators was 46.3%, 97.2, and 71.8% as compared to (II) expert re-evaluation with 59.7%, 93%, and 77.8%, respectively. Sensitivity was significantly higher at re-evaluation (P<0.001). TTE at a non-tertiary care center (P=0.012), presence of aortic aneurysm (P=0.001) and presence of severe aortic valve calcification (P=0.003) predicted an inaccurate diagnosis of BAV. Conversely, meta-analysis of published TTE studies identified a pooled sensitivity of 87.7% and a pooled specificity of 88.3% for BAV. Conclusions: The current study shows that TTE yields almost ideal diagnostic accuracy when ideal investigators examine ideal patients. However, the study also shows that TTE yields suboptimal diagnostic accuracy under routine conditions. TTE in non-tertiary care settings, concomitant aortic aneurysm, and presence of severe aortic valve calcification predict an inaccurate diagnosis of BAV.
IP innovative publication pvt. ltd, 2019
Objectives: Bicuspid Aortic Valve Disease (BAVD) is a rare entity associated with ascending aortic aneurysm. We present the histopathological and morphometric data of BAVD cases who had thoracic aortic aneurysms requiring surgical intervention. Materials and Methods: Thirteen cases of BAVD from 298 cases of ascending thoracic aortic aneurysms requiring surgical intervention between 1995 to 2009 were included. Controls were obtained from autopsy cases with normal aortic valve. Tunica intima was examined for fibrosis (FIB-1), and inflammation (INFL1). Tunica media was examined for lamellar count (LC) and inflammation (INFL 2) whereas elastic fragmentation (EF), cystic medial degeneration (CMD), medionecrosis (MN), smooth muscle disarray (SMD) and fibrosis (FIB-2) were graded by semi-quantitative grading system. CMD was subjected to morphometric area measurement. Tunica adventitia was examined for fibrosis (FIB 3) and inflammation (INFL 3). Results: In media EF (P<.001), SMD (P=.002), FIB-2 (P=.002) and MN (P=.02) were significantly greater in cases than controls. More BAVD cases had CMD (low grade =76.92%, moderate grade = 7.69% and high grade = 15.38%), when compared to only 6 controls (46.15%) having low grade CMD, although statistically not significant. Mean LC was greater in controls than cases (P= <0.001) and CMD area by morphometry using image analysis software was lesser (P=0.041) in controls than cases. The intima and adventitia did not show any significant findings. Conclusion: Patients with BAVD have significant degenerative medial changes of ascending thoracic aorta causing aneurysmal dilatation. They require surveillance, risk factor assessment and clinical disease management of aneurysmal complication.
Guidelines for management of bicuspid aortic valve aneurysms: what's the clinician to do?
Current opinion in cardiology, 2014
The timing of prophylactic ascending aortic aneurysm surgery in the setting of bicuspid aortic valve disease is complex, with multiple factors influencing the decision. The 2014 ACC/AHA Valve guidelines recommend prophylactic replacement of the aortic root and/or ascending aorta once the aortic diameter exceeds 5.5 cm. This aortic size threshold for surgery is at a larger diameter than had been recommended by the 2010 Thoracic Aortic Disease guidelines, the 2013 Society of Thoracic Surgeons Clinical Practice Guidelines, or the 2006 ACC/AHA Valve guidelines. Five recent societies or committees recently published their guidelines to assist with managing these cases. Making the decision regarding the timing of bicuspid aortic valve aneurysm surgery even more difficult are the small, but important, differences in recommendations provided among recent guidelines addressing this issue.
The American Journal of Cardiology, 2006
Dilation of the ascending aorta (AA), which is disproportionate to associated valvular lesions, is a relatively well-recognized phenomenon in patients with a bicuspid aortic valve (BAV). The aim of this study was to evaluate the rate of changes in the AA dimensions and the outcome in patients with AA dilation and BAVs compared with patients with AA dilation and tricuspid aortic valves (TAVs). Serial transesophageal echocardiograms (>12 months apart) were performed in 113 consecutive patients (BAV, n ؍ 27 and TAV, n ؍ 86) with AA diameters of >40 and <60 mm, respectively, without associated significant aortic valve stenosis or regurgitation. Baseline diameters at the sinuses of Valsalva (SV), the sinotubular junction (STJ), and the tubular tract (TT) were similar in both groups (41.3 ؎ 5.3 vs 42.3 ؎ 6.3 mm, p ؍ NS, 37.8 ؎ 5.2 vs 38.7 ؎ 5.5 mm, p ؍ NS, and 47.3 ؎ 5.3 vs 45.9 ؎ 5.1, p ؍ NS, respectively). During an average 3-year follow-up, the rate of AA diameter progression was similar for the BAV and TAV groups (0.86 ؎ 0.81 vs 0.82 ؎ 1.1 mm/year, p ؍ NS for the SV; 1.06 ؎ 1.6 vs 0.63 ؎ 1.1 mm/year, p ؍ NS for the STJ; and 0.81 ؎ 1.1 vs 0.75 ؎ 1.1 mm/year, p ؍ NS for the TT, respectively). Three patients in the TAV group experienced cardiac death (2 died suddenly and 1 after emergency surgery for AA dissection); there was no occurrence of cardiac death in the BAV group. In conclusion, the rate of progression of AA aneurysms was similar in patients with BAVs and in those with TAVs. Furthermore, patients with BAVs did not have increased rates of AA related complications compared with patients with TAVs.
Tricuspid aortic valve aneurysm
Heart, 2005
Objective: To assess the mechanisms through which an enlarged aortic root may facilitate right to left shunting through a patent foramen ovale. Patients: 19 patients with the platypnoea-orthodeoxia syndrome (POS) were compared with 30 control patients without platypnoea. Interventions: Multiplane transoesophageal echocardiography. Main outcome measures: The aortic root diameter, atrial septal dimension behind the aortic root, and amplitude of the phasic oscillation of the septum were measured. Four groups of patients were compared: 12 platypnoeic patients with a dilated aortic root (POS-D), 7 platypnoeic patients with a normal aortic root (POS-N), 15 control patients with a dilated aortic root (CONT-D), and 15 control patients with a normal aortic root (CONT-N). Results: In POS-D and CONT-D patients, the apparent atrial septal dimension was 16.3 (2.7) mm and 17.4 (5.9) mm respectively, compared with 24.4 (5.2) mm in POS-N patients and 25 (4) mm in CONT-N (p , 0.005). Furthermore, the amplitude of septal oscillation was 14.7 (2.5) mm in the POS-D group versus 5.8 (2.4) mm in CONT-N (p , 0.001) compared with 23.3 (3) mm in seven patients with an atrial septal aneurysm (p ,0.001). Conclusion: Patients with an enlarged aorta have an apparently smaller dimension and increased mobility of the atrial septum. These findings appear to result from compression by the aortic root and decreased septal tautness. Consequently, a ''spinnaker effect'' with the inferior vena caval flow may take place, opening the foramen ovale and leading to sustained right to left shunting. A patent foramen ovale (PFO) is a defect in the atrial septum that results from incomplete fusion of the septum primum to the septum secundum. The persistence of a PFO into adulthood may lead to several complications, including paradoxical embolism of thrombus, air or tumoural material, and refractory hypoxaemia.
Should We Operate on Thoracic Aortic Aneurysm of 5-5.5cm in Bicuspid Aortic Valve Disease Patients
Background: This study aims to determine the longterm outcomes and rate of reoperation among BAV patients with aortic diameter of 5-5.5cm who underwent immediate surgical repair versus surveillance. Methods: A total of 148 BAV patients with aortic aneurysm measuring 5-5.5cm were identified between 1993 to 2019. Patients were categorized into two groups: immediately operated (n=89), versus watched group (n=59) i.e., monitored until either symptomatic, aortic diameter ≥ 5.5 cm or operated at surgeons' discretion/patient preference. Results: Compared to the immediately operated group the watched group had significantly lower proportion of proximal aorta replacement (86% vs 100%). The mean size of proximal thoracic aorta at initial encounter, including aortic root, ascending, and arch, for the watched group was 52.1 ± 1.62mm and 52.6 ± 1.81mm in the immediately operated group, p=0.06. There was no significant difference in 10-year survival between the watched group 94% (95% CI: 79%, 99%) vs immediately operated group 96.5% (95% CI: 86%, 99%), p=0.90. Initial operation rate for the watched group during 10-year follow-up was 85%. The operative mortality in both groups was 0%. The 10-year reoperation rate between groups was
World Neurosurgery, 2010
Despite the high prevalence of intracranial aneurysms (ICAs) and the associated morbidity of rupture, no criteria have yet been developed for screening the general population. Improvements in magnetic resonance angiography sensitivity, a reduction in its cost, and greater insight into risk factors could pave the way for a rational screening approach. Aortic and intracranial aneurysms have been historically regarded as very different diseases, but recent biological studies have suggested some commonalities. Recently, a link between the two entities has been suggested but it has not been well established. To better understand this potential association, Kuzmik et al. from the Yale University School of Medicine (Am J Cardiol 2010 105:417-420.) analyzed 1560 patients who underwent thoracic aortic aneurysm (TAA) repair and found that 212 of them also had an ICA. Fifty-two patients were found retrospectively, and 160 were found prospectively.