1
|
Katsaros O, Ktenopoulos N, Korovesis T, Benetos G, Apostolos A, Koliastasis L, Sagris M, Milaras N, Latsios G, Synetos A, Drakopoulou M, Tsalamandris S, Karanasos A, Tsioufis K, Toutouzas K. Bicuspid Aortic Valve Disease: From Pathophysiology to Treatment. J Clin Med 2024; 13:4970. [PMID: 39274183 PMCID: PMC11396317 DOI: 10.3390/jcm13174970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 08/10/2024] [Accepted: 08/18/2024] [Indexed: 09/16/2024] Open
Abstract
The Bicuspid Aortic Valve (BAV) is the most common congenital anomaly in adults, with a global incidence of 1.3%. Despite being well documented, BAV presents significant clinical challenges due to its phenotypic heterogeneity, diverse clinical manifestations, and variable outcomes. Pathophysiologically, BAV differs from tricuspid valves in calcification patterns and hemodynamic effects, leading to increased shear stress and aortic root dilatation, while it is influenced by genetic and hemodynamic factors. This is why therapeutically, BAV presents challenges for both surgical and transcatheter interventions, with surgical approaches being traditionally preferred, especially when aortopathy is present. However, transcatheter aortic valve implantation (TAVI) has emerged as a viable option, with studies showing comparable outcomes to surgery in selected patients, while advancements in TAVI and a better understanding of BAV's genetic and pathophysiological nuances are expanding treatment options. The choice between mechanical and bioprosthetic valves also presents considerations, particularly regarding long-term durability and the need for anticoagulation. Future research should focus on long-term registries and genetic studies to refine therapeutic strategies and improve patient outcomes. This review aims to evaluate current approaches in the surgical and interventional management of BAV, focusing on its anatomy, pathogenesis, pathophysiology, and therapeutic strategies.
Collapse
Affiliation(s)
- Odysseas Katsaros
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece
| | - Nikolaos Ktenopoulos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece
| | - Theofanis Korovesis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece
| | - Georgios Benetos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece
| | - Anastasios Apostolos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece
| | - Leonidas Koliastasis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece
| | - Marios Sagris
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece
| | - Nikias Milaras
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece
| | - George Latsios
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece
| | - Andreas Synetos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece
- Medical School, European University of Cyprus, Nicosia 1516, Cyprus
| | - Maria Drakopoulou
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece
| | - Sotirios Tsalamandris
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece
| | - Antonios Karanasos
- Department of Cardiology, Patras University Hospital, 26504 Patras, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece
| | - Konstantinos Toutouzas
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece
| |
Collapse
|
2
|
Zhang C, Butt S, Kashif H, Rowe C, Harky A, Zeinah M. Aortic Valve Replacement and Repair With or Without Concomitant Ascending Aorta Replacement: Impact on Outcomes: A Systematic Review. Cardiol Rev 2023:00045415-990000000-00168. [PMID: 37882686 DOI: 10.1097/crd.0000000000000623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
Aortic valve surgery is a common procedure used to treat significant aortic valve stenosis or insufficiency. Some of these patients have coexisting pathology affecting the ascending aorta requiring ascending aorta replacement (AAR). Although the outcomes of these procedures are independently positive, it is proposed that concomitant AAR improves outcomes and minimizes the chances of future ascending aorta replacement. A comprehensive literature search for relevant studies published since 2010 comparing outcomes of aortic valve repair and replacement with or without concomitant ascending aorta replacement was undertaken using electronic databases PubMed, Cochrane Library, Embase Ovid, and SCOPUS. Major exclusion criteria were (1) conference posters, literature reviews, editorials; (2) aortic root surgery, aortic arch surgery, or other surgeries (3) case series with less than 5 participants. A total of 1189 patients from 6 retrospective cohort studies were included in the final review, from which clinical outcomes such as mortality and complications were compared. Mortality rates were similar in both intervention groups. No significant differences were found between the 2 groups in reexploration rates due to bleeding, stroke, postoperative dialysis, and atrial fibrillation. Survival rates varied but had no significant difference between interventions. Both isolated aortic valve surgery and concomitant AAR procedures offer comparable favourable outcomes in terms of mortality, survival rates, and complication risks. However, the evidence is limited by the lack of randomized controlled trials. We recommend that future studies should standardize reporting on postoperative recovery, complications, long-term freedom from reoperations, and long-term changes to aorta dimensions.
Collapse
Affiliation(s)
- Chen Zhang
- From the Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Sundas Butt
- Department of Plastic Surgery, Nottingham City Hospital, Nottingham, United Kingdom
| | - Hadi Kashif
- Department of Acute Medicine, King's College Hospital, London, United Kingdom
| | - Clarissa Rowe
- Faculty of Medicine, Department of Medicine, Imperial College London, London, United Kingdom
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Mohamed Zeinah
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
- Faculty of Medicine, Ain Shams University, Cairo Egypt
| |
Collapse
|
3
|
Bibevski S, Ruzmetov M, Plate JF, Scholl FG. The Impact of Bicuspid Aortic Valve Leaflet Fusion Morphology on the Ascending Aorta and on Outcomes of Aortic Valve Replacement. Tex Heart Inst J 2023; 50:491701. [PMID: 36972539 PMCID: PMC10178649 DOI: 10.14503/thij-21-7831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
BACKGROUND Patients with bicuspid aortic valves (BAVs) tend to develop dilation of the ascending aorta. The aim of this study was to analyze the impact of leaflet fusion pattern on aortic root diameter and outcomes in patients undergoing surgery for BAV vs tricuspid aortic valve (TAV) disease. METHODS This is a retrospective review of 90 patients with aortic valve disease (mean [SD] age, 51.5 [8.2] years) who underwent aortic valve replacement for BAV (n = 60) and TAV (n = 30). Fusion of right-left (R/L) coronary cusps was identified in 45 patients, whereas the remaining 15 patients had right-noncoronary (R/N) cusp fusion. Aortic diameter was measured at 4 levels, and Z values were computed. RESULTS There were no significant differences between the BAV and TAV groups for age, weight, aortic insufficiency grade, or size of implanted prostheses. However, a higher preoperative peak gradient at the aortic valve was significantly associated with R/L fusion (P = .02). Preoperative Z values of ascending aorta and sinotubular junction diameter were significantly higher in patients with R/N fusion than with the R/L (P < .001 and P = .04, respectively) and TAV (P < .001 and P < .05, respectively) subgroups. During the follow-up period (mean [SD], 2.7 [1.8] years), 3 patients underwent a redo procedure. At the last follow-up, the sizes of ascending aorta were similar among all 3 patient groups. CONCLUSION This study suggests that preoperative dilation of the ascending aorta is more common in patients with R/N fusion than in patients with R/L and TAV but is not significantly different between all groups in the early follow-up period. R/L fusion was associated with an increased risk of preoperative presence of aortic stenosis.
Collapse
Affiliation(s)
- Steve Bibevski
- Section of Pediatric Cardiothoracic Surgery, Joe DiMaggio Children's Hospital, Hollywood, Florida
| | - Mark Ruzmetov
- Section of Pediatric Cardiothoracic Surgery, Joe DiMaggio Children's Hospital, Hollywood, Florida
| | - Juan F Plate
- Section of Adult Cardiac Surgery, Memorial Regional Hospital, Hollywood, Florida
| | - Frank G Scholl
- Section of Pediatric Cardiothoracic Surgery, Joe DiMaggio Children's Hospital, Hollywood, Florida
| |
Collapse
|
4
|
Kusner JJ, Brown JY, Gleason TG, Edelman ER. The Natural History of Bicuspid Aortic Valve Disease. STRUCTURAL HEART 2022. [DOI: 10.1016/j.shj.2022.100119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
5
|
Kaiser AD, Shad R, Schiavone N, Hiesinger W, Marsden AL. Controlled Comparison of Simulated Hemodynamics Across Tricuspid and Bicuspid Aortic Valves. Ann Biomed Eng 2022; 50:1053-1072. [PMID: 35748961 PMCID: PMC10775905 DOI: 10.1007/s10439-022-02983-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 05/16/2022] [Indexed: 11/01/2022]
Abstract
Bicuspid aortic valve is the most common congenital heart defect, affecting 1-2% of the global population. Patients with bicuspid valves frequently develop dilation and aneurysms of the ascending aorta. Both hemodynamic and genetic factors are believed to contribute to dilation, yet the precise mechanism underlying this progression remains under debate. Controlled comparisons of hemodynamics in patients with different forms of bicuspid valve disease are challenging because of confounding factors, and simulations offer the opportunity for direct and systematic comparisons. Using fluid-structure interaction simulations, we simulate flows through multiple aortic valve models in a patient-specific geometry. The aortic geometry is based on a healthy patient with no known aortic or valvular disease, which allows us to isolate the hemodynamic consequences of changes to the valve alone. Four fully-passive, elastic model valves are studied: a tricuspid valve and bicuspid valves with fusion of the left- and right-, right- and non-, and non- and left-coronary cusps. The resulting tricuspid flow is relatively uniform, with little secondary or reverse flow, and little to no pressure gradient across the valve. The bicuspid cases show localized jets of forward flow, excess streamwise momentum, elevated secondary and reverse flow, and clinically significant levels of stenosis. Localized high flow rates correspond to locations of dilation observed in patients, with the location related to which valve cusps are fused. Thus, the simulations support the hypothesis that chronic exposure to high local flow contributes to localized dilation and aneurysm formation.
Collapse
Affiliation(s)
- Alexander D Kaiser
- Institute for Computational & Mathematical Engineering, Stanford University, Stanford, CA, USA
- Department of Pediatrics (Cardiology), Stanford University, Stanford, CA, USA
- Stanford Cardiovascular Institute, Stanford, CA, USA
| | - Rohan Shad
- Stanford Cardiovascular Institute, Stanford, CA, USA
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Nicole Schiavone
- Department of Mechanical Engineering, Stanford University, Stanford, CA, USA
| | - William Hiesinger
- Stanford Cardiovascular Institute, Stanford, CA, USA
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Alison L Marsden
- Institute for Computational & Mathematical Engineering, Stanford University, Stanford, CA, USA.
- Department of Pediatrics (Cardiology), Stanford University, Stanford, CA, USA.
- Stanford Cardiovascular Institute, Stanford, CA, USA.
- Department of Mechanical Engineering, Stanford University, Stanford, CA, USA.
- Department of Bioengineering, Stanford University, Stanford, CA, USA.
| |
Collapse
|
6
|
Martens S. Avoiding the catastrophe: aortic wall biomechanical properties and possible aortic dissection. Eur J Cardiothorac Surg 2021; 61:376-377. [PMID: 34918070 DOI: 10.1093/ejcts/ezab539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 11/22/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Sven Martens
- Department of Cardiothoracic Surgery, University Hospital Münster, Münster, Germany
| |
Collapse
|
7
|
Chew NWS, Phua K, Ngiam JN, Cheong C, Kong G, Ng JLM, Sia CH, Loh PH, Lee CH, Wong RCC, Poh KK, Yeo TC, Kong WKF. Inter-Ethnic Differences in Valvular Dysfunction, Aortopathy, and Progression of Disease of an Asian Bicuspid Aortic Valve Population. Heart Lung Circ 2021; 31:469-479. [PMID: 34844903 DOI: 10.1016/j.hlc.2021.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 10/02/2021] [Accepted: 10/30/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND There are differences in bicuspid aortic valve (BAV) characteristics between Asian and European populations, but little is known about the inter-ethnic differences in bicuspid valve function and aortic root dimensions within the diverse Asian population. METHODS From 1992-2017, 562 patients with index echocardiographic diagnosis of BAV in a tertiary health care institution in Singapore were analysed according to their ethnic groups: Chinese, Malay, Indian, and Eurasian. Study outcomes included BAV complications (infective endocarditis, aortic dissection) and clinical outcomes (aortic valve surgery, aortic root surgery, all-cause mortality). Total events were defined as composite outcome of all BAV complications and outcomes. Aortic dimensions and aortic dilatation rates were also studied. RESULTS There were 379 (67.5%) Chinese, 79 (14.0%) Malay, 73 (13.0%) Indian, and 31 (5.5%) Eurasian patients. Type 1 BAV (58.5%) was the most prevalent BAV morphology, with moderate-to-severe aortic stenosis (AS) (36.8%) being the most common complication in the overall population. There was a higher prevalence of type 0 BAV in Chinese and Indian groups, and type 1 BAV with fusion of left-right coronary cusp in Eurasian and Malay groups (p=0.082). There was no difference in significant AS among groups. The highest prevalence of moderate-to-severe aortic regurgitation was observed amongst the Eurasian group, followed by Chinese, Indian, and Malay groups (p=0.033). The Chinese group had the largest mean indexed diameters of the aortic root. Multivariable linear regression demonstrated that only the Chinese had significantly larger indexed diameters in the aortic annulus, sinotubular junction (STJ), and ascending aorta (AA), relative to the Eurasian group, after adjusting for age, sex, smoking, hypertension, hyperlipidaemia, diabetes, and aortic regurgitation. On follow-up echocardiography, there was a trend towards the highest dilatation rates of sinus of Valsalva and STJ amongst Indian, and AA amongst Malay groups. Kaplan-Meier curves showed the highest incidence of total events amongst Chinese, followed by Malay, Indian and Eurasian (log-rank=9.691; p=0.021) patients. CONCLUSION There were differences in BAV morphology, valve dysfunction, aortopathy, and prognosis within the Asian population. Chinese patients had one of the highest prevalence of significant aortic regurgitation, with the largest aortic dimensions and worst outcomes compared with other Asian ethnicities. Closer surveillance is warranted in BAV patients within the Asian population.
Collapse
Affiliation(s)
- Nicholas W S Chew
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore. https://twitter.com/elisabettasabet
| | - Kailun Phua
- Department of Medicine, National University Health System, Singapore
| | | | - Clare Cheong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gwyneth Kong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Julia L M Ng
- Pharmacy and Therapeutics Office, Group Health Informatics, National Healthcare Group, Singapore
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Poay-Huan Loh
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chi-Hang Lee
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Raymond C C Wong
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kian-Keong Poh
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tiong-Cheng Yeo
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - William K F Kong
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| |
Collapse
|
8
|
Uimonen M. Synthesis of multidimensional pathophysiological process leading to type A aortic dissection: a narrative review. J Thorac Dis 2021; 13:6026-6036. [PMID: 34795949 PMCID: PMC8575841 DOI: 10.21037/jtd-21-829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/06/2021] [Indexed: 11/06/2022]
Abstract
Objective This review aims to synthesize the existing knowledge on the etiological process leading to type A aortic dissection (TAAD) and to clarify the relationship between mechanical, biochemical, and histopathological processes behind the aortic disease. Background Extensive research has previously identified several risk factors for TAAD as well as pathological mechanisms leading to TAAD. However, due to the complexity of the pathological process and limited knowledge on the relationships between distinct pathomechanisms leading to TAAD, the ability to identify the patients at high risk for TAAD has been poor. Methods PubMed (National Library of Medicine) database was searched for suitable literature. The most relevant articles focusing on anatomy, histopathology, physiology, and mechanics of ascending aorta and aortic diseases were reviewed. Conclusions Pathophysiology of the TAAD is related to biochemical and histological as well as mechanical and hemodynamic alterations leading to a degeneration of the aortic wall via inflammatory response. The degradative mechanisms of aortic wall structures and the mechanical forces, to which the wall is predisposed, are interrelated and influence one another. The relativity between the factors influencing aortic wall strength and healing capacity, and factors influencing mechanical stress on the aortic wall suggest that the risk of TAAD is not a linear but rather a dynamic phenomenon. Accounting for the dynamical property of the aortic disease in assessing the need for preventive surgical aortic reconstruction may provide a wider perspective in identifying patients at risk of TAAD and in planning preventive medical therapies.
Collapse
Affiliation(s)
- Mikko Uimonen
- Department of Surgery, Central Finland Hospital Nova, Jyväskylä, Finland
| |
Collapse
|
9
|
Lim MS, Celermajer DS, Bannon PG. Bicuspid aortic valve disease - the influence of valve morphotype on age at and types of surgical treatment. IJC HEART & VASCULATURE 2021; 34:100786. [PMID: 33997259 PMCID: PMC8100620 DOI: 10.1016/j.ijcha.2021.100786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/15/2021] [Accepted: 04/12/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Patients with bicuspid aortic valve (BAV) with zero or two raphes have been under-represented in previous studies. Whether these patients have unique clinical courses remains unclear. We describe the indications for and types of surgery in patients with BAV, and describe differences between valve morphotypes. METHODS Adults who had undergone aortic and/or aortic valve surgery for BAV disease at our centres were identified and classified according to the Sievers definitions. RESULTS 317 patients were included (74.4% male, median age at surgery 62 years). Of these, 187 (59.0%) had aortic valve surgery, 7 (2.2%) aortic surgery, 120 (37.9%) combined valve and aortic surgery and 3 had a Ross procedure. Most patients had aortic stenosis (71.9%), followed by aortic regurgitation (16.7%). 30-day mortality was low (1.6%).The commonest valve morphology was type-1 (one raphe) in 89.6%; type-0 (no raphes) occurred in 7.9% and type-2 (two raphes) in 2.5%. Patients with type-2 valves were substantially younger at time of surgery than type-1 patients (median 36 vs 63 years, p = 0.008). A higher proportion of patients with type-0 valves required aortic surgery than those with type-1 (68.0% vs 37.3%, p = 0.007). There were no differences between groups for the indication for surgery, valvular abnormality or 30-day mortality. CONCLUSIONS The number of BAV raphes was independently and significantly associated with age at surgery and the need for aortic intervention. Patients with type 0 and type 2 valves are a small but important proportion of the BAV population, potentially requiring different clinical surveillance and management.
Collapse
Affiliation(s)
- Michelle S. Lim
- The University of Sydney, Faculty of Medicine and Health, Camperdown, New South Wales, Australia
- Royal Prince Alfred Hospital, Department of Cardiology, Camperdown, New South Wales, Australia
| | - David S. Celermajer
- The University of Sydney, Faculty of Medicine and Health, Camperdown, New South Wales, Australia
- Royal Prince Alfred Hospital, Department of Cardiology, Camperdown, New South Wales, Australia
- Heart Research Institute, Sydney, Australia
| | - Paul G. Bannon
- The University of Sydney, Faculty of Medicine and Health, Camperdown, New South Wales, Australia
- Royal Prince Alfred Hospital, Department of Cardiothoracic Surgery, Camperdown, New South Wales, Australia
| |
Collapse
|
10
|
D'Ascenzi F, Valentini F, Anselmi F, Cavigli L, Bandera F, Benfari G, D'Andrea A, Di Salvo G, Esposito R, Evola V, Malagoli A, Elena Mandoli G, Santoro C, Galderisi M, Mondillo S, Cameli M. Bicuspid aortic valve and sports: From the echocardiographic evaluation to the eligibility for sports competition. Scand J Med Sci Sports 2020; 31:510-520. [PMID: 33260267 DOI: 10.1111/sms.13895] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 10/23/2020] [Accepted: 11/27/2020] [Indexed: 12/19/2022]
Abstract
Bicuspid aortic valve (BAV) is the most common congenital heart defect in adults. Although a BAV may remain without clinical consequences for a lifetime, it can deteriorate in aortic valve stenosis and regurgitation and aortic dilatation. Unfortunately, the impact of regular training on patients with BAV and its natural course is not fully understood, although preliminary evidence suggests that the progression of valvular disease occurs primarily in an independent manner from sports practice. The current review aims to report how to perform a comprehensive echocardiographic examination in athletes with BAV and analyze the current literature on the influence of sports practice and how it impacts the aortic valve in athletes with BAV. The article also summarizes the current recommendations on sports eligibility and disqualification for competitive athletes with BAV.
Collapse
Affiliation(s)
- Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Francesca Valentini
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Francesca Anselmi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Luna Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Francesco Bandera
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Giovanni Benfari
- Department of Medicine, Section of Cardiology, University of Verona, Verona, Italy
| | - Antonello D'Andrea
- Department of Cardiology, Umberto I° Hospital Nocera Inferiore, Salerno, Italy
| | | | - Roberta Esposito
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Vincenzo Evola
- Department of Clinical and Experimental Medicine, University of Palermo, Palermo, Italy
| | | | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Sergio Mondillo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | | |
Collapse
|
11
|
Kalinowski ME, Szulik M, Pawlak S, Rybus-Kalinowska B, Zembala M, Kalarus Z, Kukulski T. The impact of the aortic cusps fusion pattern and valve disease severity on the aortic wall mechanics in patients with bicuspid aortic valve. Int J Cardiovasc Imaging 2020; 36:1429-1436. [PMID: 32303878 PMCID: PMC7381436 DOI: 10.1007/s10554-020-01838-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 04/02/2020] [Indexed: 11/25/2022]
Abstract
The ascending aorta dilatation in the bicuspid aortic valve (BAV) patients is often attributed to congenital abnormalities of the aortic wall, but it may be related to hemodynamic disturbances in the course of BAV disease. At present, ascending aortic diameter is used as almost sole but weak predictor of aortic dissection and rupture in BAV. We examined the association between aortic wall mechanics and severity of aortic valve disease including different cusps fusion patterns using conventional echocardiography and tissue Doppler imaging (TDI). We prospectively studied 106 BAV patients: 72 with right-left (R-L) coronary cusp fusion were matched 1:1 to 34 patients with right-noncoronary (R-N) cusp fusion obtaining 34 pairs of patients. Peak systolic radial velocity and acceleration of the ascending aortic wall, measured by TDI, were used as an index of hemodynamic stress imposed on the aorta. Paired analysis showed higher aortic wall radial velocity (4.71 ± 1.61 cm/s vs. 3.33 ± 1.44 cm/s, p = 0.001) and acceleration (1.08 ± 0.46 m/s2 vs. 0.80 ± 0.34 m/s2, p = 0.015) in-R-L compared to R-N fusion. Pearson correlation showed association of ascending tubular aortic diameter with age (r = 0.258, p = 0.012), weight (r = 0.323, p = 0.001), peak aortic valve gradient (r = 0.386, p = 0.0001), aortic root diameter (r = 0.439, p < 0.0001), and R-N fusion pattern (r = 0.209, p = 0.043). Aortic root diameter was related to male gender (r = 0.296, p = 0.003), weight (r = 0.381, p = 0.0001), ascending aortic diameter (r = 0.439, p < 0.0001), and severity of aortic regurgitation (r = 0.337, p = 0.0009). Regional differences in aortic wall motion between different BAV cusp fusion patterns and association of aortic diameters with the severity of aortic valve disease, both suggest a deleterious hemodynamic impact of cusp fusion patterns and aortic valve dysfunction on ascending aortic wall. Assessment of aortic hemodynamic by TDI is feasible and could be potentially used to improve prediction of acute aortic complications, thus helping to establish optimal timing of aortic surgery in BAV patients.
Collapse
Affiliation(s)
- Mariusz E Kalinowski
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantation, Silesian Center for Heart Diseases, Faculty of Medical Science in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Mariola Szulik
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Faculty of Medical Science in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Szymon Pawlak
- Department of Cardiac Surgery, Heart Transplantation and Mechanical Support in Children, Silesian Center for Heart Diseases, Zabrze, Faculty of Medical Science in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Barbara Rybus-Kalinowska
- Department of Basic Medical Sciences, School of Public Health in Bytom, Medical University of Silesia, Katowice, Poland
| | - Marian Zembala
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantation, Silesian Center for Heart Diseases, Faculty of Medical Science in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Zbigniew Kalarus
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Faculty of Medical Science in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Tomasz Kukulski
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Faculty of Medical Science in Zabrze, Medical University of Silesia, Katowice, Poland.
| |
Collapse
|
12
|
Blais S, Meloche-Dumas L, Fournier A, Dallaire F, Dahdah N. Long-Term Risk Factors for Dilatation of the Proximal Aorta in a Large Cohort of Children With Bicuspid Aortic Valve. Circ Cardiovasc Imaging 2020; 13:e009675. [DOI: 10.1161/circimaging.119.009675] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Patients with bicuspid aortic valve (BAV) have a higher risk of developing aortic valve dysfunction and progressive proximal aorta dilatation, which can lead to aortic dissection. To this day, identification of children at risk of developing severe aortic dilatation during their pediatric follow-up is still challenging because most studies were restricted to adult subjects. The overarching goal of this study was to identify risk factors of aortic dilatation in children with BAV.
Methods:
We extracted clinical and echocardiographic data of all BAV subjects aged 0 to 20 years followed at Centre Hospitalier Universitaire Sainte-Justine between 1999 and 2016. We excluded subjects with concomitant heart defects and conditions affecting proximal aorta dimensions. Proximal aorta diameters (expressed as
Z
scores) were modeled in relation to age and potential predictive variables in a linear mixed model. The primary outcome was the rate of dilatation.
Results:
We included 761 subjects (3134 echocardiograms) in final analyses. The mean ascending aorta
Z
score progression rate for BAV patient with a normally functioning aortic valve was estimated at 0.05
Z
score unit per year. The strongest predictors of an increased dilatation rate were severe aortic stenosis, moderate and severe aortic regurgitation, and uncorrected coarctation of the aorta. Aortic valve leaflet fusion pattern and sex were not associated with progression rate.
Conclusions:
Children with a normally functioning BAV exhibited a very slow proximal aorta dilatation rate. Ascending aorta dilatation rate was significantly increased in patients with more than mild aortic valve dysfunction but was independent from BAV leaflet fusion type.
Collapse
Affiliation(s)
- Samuel Blais
- Department of Pediatrics, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Canada (S.B., F.D.)
| | - Léamarie Meloche-Dumas
- Department of General Surgery, Maisonneuve-Rosemont Hospital, Montreal, Canada (L.M.-D.)
| | - Anne Fournier
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Canada (A.F., N.D.)
| | - Frederic Dallaire
- Department of Pediatrics, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Canada (S.B., F.D.)
| | - Nagib Dahdah
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Canada (A.F., N.D.)
| |
Collapse
|
13
|
Fernández B, Soto-Navarrete MT, López-García A, López-Unzu MÁ, Durán AC, Fernández MC. Bicuspid Aortic Valve in 2 Model Species and Review of the Literature. Vet Pathol 2020; 57:321-331. [DOI: 10.1177/0300985819900018] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Bicuspid aortic valve (BAV) is the most common human congenital cardiac malformation. Although the etiology is unknown for most patients, formation of the 2 main BAV anatomic types (A and B) has been shown to rely on distinct morphogenetic mechanisms. Animal models of BAV include 2 spontaneous hamster strains and 27 genetically modified mouse strains. To assess the value of these models for extrapolation to humans, we examined the aortic valve anatomy of 4340 hamsters and 1823 mice from 8 and 7 unmodified strains, respectively. In addition, we reviewed the literature describing BAV in nonhuman mammals. The incidences of BAV types A and B were 2.3% and 0.03% in control hamsters and 0% and 0.3% in control mice, respectively. Hamsters from the spontaneous model had BAV type A only, whereas mice from 2 of 27 genetically modified strains had BAV type A, 23 of 27 had BAV type B, and 2 of 27 had both BAV types. In both species, BAV incidence was dependent on genetic background. Unlike mice, hamsters had a wide spectrum of aortic valve morphologies. We showed interspecific differences in the occurrence of BAV between humans, hamsters, and mice that should be considered when studying aortic valve disease using animal models. Our results suggest that genetic modifiers play a significant role in both the morphology and incidence of BAV. We propose that mutations causing anomalies in specific cardiac morphogenetic processes or cell lineages may lead to BAV types A, B, or both, depending on additional genetic, environmental, and epigenetic factors.
Collapse
Affiliation(s)
- Borja Fernández
- Departamento de Biología Animal, Facultad de Ciencias, Universidad de Málaga, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
- CIBERCV Enfermedades Cardiovasculares, Málaga, Spain
| | - María Teresa Soto-Navarrete
- Departamento de Biología Animal, Facultad de Ciencias, Universidad de Málaga, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Alejandro López-García
- Departamento de Biología Animal, Facultad de Ciencias, Universidad de Málaga, Málaga, Spain
| | - Miguel Ángel López-Unzu
- Departamento de Biología Animal, Facultad de Ciencias, Universidad de Málaga, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Ana Carmen Durán
- Departamento de Biología Animal, Facultad de Ciencias, Universidad de Málaga, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - M. Carmen Fernández
- Departamento de Biología Animal, Facultad de Ciencias, Universidad de Málaga, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| |
Collapse
|
14
|
Borger MA, Fedak PWM, Stephens EH, Gleason TG, Girdauskas E, Ikonomidis JS, Khoynezhad A, Siu SC, Verma S, Hope MD, Cameron DE, Hammer DF, Coselli JS, Moon MR, Sundt TM, Barker AJ, Markl M, Della Corte A, Michelena HI, Elefteriades JA. The American Association for Thoracic Surgery consensus guidelines on bicuspid aortic valve-related aortopathy: Full online-only version. J Thorac Cardiovasc Surg 2019; 156:e41-e74. [PMID: 30011777 DOI: 10.1016/j.jtcvs.2018.02.115] [Citation(s) in RCA: 169] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 01/17/2018] [Accepted: 02/12/2018] [Indexed: 12/11/2022]
Abstract
Bicuspid aortic valve disease is the most common congenital cardiac disorder, being present in 1% to 2% of the general population. Associated aortopathy is a common finding in patients with bicuspid aortic valve disease, with thoracic aortic dilation noted in approximately 40% of patients in referral centers. Several previous consensus statements and guidelines have addressed the management of bicuspid aortic valve-associated aortopathy, but none focused entirely on this disease process. The current guidelines cover all major aspects of bicuspid aortic valve aortopathy, including natural history, phenotypic expression, histology and molecular pathomechanisms, imaging, indications for surgery, surveillance, and follow-up, and recommendations for future research. It is intended to provide clinicians with a current and comprehensive review of bicuspid aortic valve aortopathy and to guide the daily management of these complex patients.
Collapse
Affiliation(s)
- Michael A Borger
- Leipzig Heart Center, Cardiac Surgery, University of Leipzig, Leipzig, Germany.
| | - Paul W M Fedak
- Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Thomas G Gleason
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Evaldas Girdauskas
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - John S Ikonomidis
- Division of Cardiothoracic Surgery, University of North Carolina, Chapel Hill, NC
| | - Ali Khoynezhad
- Memorial Care Heart and Vascular Institute, Memorial Care Long Beach Medical Center, Long Beach, Calif
| | - Samuel C Siu
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Subodh Verma
- Department of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Michael D Hope
- San Francisco (UCSF) Department of Radiology & Biomedical Imaging, University of California, San Francisco, Calif
| | - Duke E Cameron
- Department of Cardiac Surgery, Massachusetts General Hospital, Boston, Mass
| | - Donald F Hammer
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Joseph S Coselli
- Division of Cardiothoracic Surgery, Texas Heart Institute, Baylor College of Medicine, Houston, Tex
| | - Marc R Moon
- Section of Cardiac Surgery, Washington University School of Medicine, St Louis, Mo
| | - Thoralf M Sundt
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Mass
| | - Alex J Barker
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Michael Markl
- Departments of Radiology and Biomedical Engineering, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | | | | | - John A Elefteriades
- Department of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, Conn
| |
Collapse
|
15
|
Oner T, Akgun G, Ergin SO, Karadag H, Yucel İK, Celebi A. Risk Factors Associated with Ascending Aortic Aneurysms and Aortic Elasticity Parameters in Children with a Bicuspid Aortic Valve. Pediatr Cardiol 2019; 40:980-986. [PMID: 31016325 DOI: 10.1007/s00246-019-02102-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 04/05/2019] [Indexed: 11/28/2022]
Abstract
Aneurysms of the ascending aorta are frequently found in patients with a bicuspid aortic valve (BAV). This study assessed the risk factors of ascending aortic aneurysms and aortic elasticity in children with BAV. The study included 66 patients with no history of transcatheter intervention or surgical procedure who had been diagnosed with isolated BAV. Echocardiographic, blood pressure, and pulse measurements were obtained for all patients. The BAVs were classified as described by Sievers et al. (J Thorac Cardiovasc Surg 133:1226-1233, 2007), and aortic elasticity parameters were calculated using various formulas. The patients were divided into groups with and without cusp fusion, aortic stenosis (AS), aortic regurgitation (AR), or mixed lesions; the groups were then compared. The mean patient age was 10.43 ± 3.91 years; 15%he patients had no AS or AR, 33% had both AS and AR, 17% had AS alone, and 35% had AR alone. The most common type of BAV was type 5, and the ascending aorta z-scores were higher in children with mixed lesions and without a cusp fusion. Aortic distensibility (AD) was significantly higher, and the stiffness index was significantly lower, in patients with an ascending aorta z-score > 4. The ascending aortic z-scores were higher in the no-fusion and mixed lesion (AS + AR) groups, especially those originating from post-stenotic dilation due to AS. The AD was increased in patients with an ascending aorta z-score > 4. Patients should thus be monitored closely for dissection risk, and preventive medical treatment should be started early in those with AS without cusp fusion.
Collapse
Affiliation(s)
- Taliha Oner
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Uskudar, Istanbul, Turkey.
| | - Gokmen Akgun
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Uskudar, Istanbul, Turkey
| | - Selma Oktay Ergin
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Uskudar, Istanbul, Turkey
| | - Huseyin Karadag
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Uskudar, Istanbul, Turkey
| | - İlker Kemal Yucel
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Uskudar, Istanbul, Turkey
| | - Ahmet Celebi
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Uskudar, Istanbul, Turkey
| |
Collapse
|
16
|
Farag ES, van Ooij P, Planken RN, Dukker KC, de Heer F, Bouma BJ, Robbers‐Visser D, Groenink M, Nederveen AJ, de Mol BA, Kluin J, Boekholdt SM. Aortic valve stenosis and aortic diameters determine the extent of increased wall shear stress in bicuspid aortic valve disease. J Magn Reson Imaging 2018; 48:522-530. [PMID: 29451963 PMCID: PMC6099246 DOI: 10.1002/jmri.25956] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 01/05/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Use of 4-dimensional flow magnetic resonance imaging (4D-flow MRI) derived wall shear stress (WSS) heat maps enables identification of regions in the ascending aorta with increased WSS. These regions are subject to dysregulation of the extracellular matrix and elastic fiber degeneration, which is associated with aortic dilatation and dissection. PURPOSE To evaluate the effect of the presence of aortic valve stenosis and the aortic diameter on the peak WSS and surface area of increased WSS in the ascending aorta. STUDY TYPE Prospective. SUBJECTS In all, 48 bicuspid aortic valve (BAV) patients (38.1 ± 12.4 years) and 25 age- and gender-matched healthy individuals. FIELD STRENGTH/SEQUENCE Time-resolved 3D phase contrast MRI with three-directional velocity encoding at 3.0T. ASSESSMENT Peak systolic velocity, WSS, and aortic diameters were assessed in the ascending aorta and 3D heat maps were used to identify regions with elevated WSS. STATISTICAL TESTS Comparisons between groups were performed by t-tests. Correlations were investigated by univariate and multivariate regression analysis. RESULTS Elevated WSS was present in 15 ± 11% (range; 1-35%) of the surface area of the ascending aorta of BAV patients with aortic valve stenosis (AS) (n = 10) and in 6 ± 8% (range; 0-31%) of the ascending aorta of BAV patients without AS (P = 0.005). The mid-ascending aortic diameter negatively correlated with the peak ascending aortic WSS (R = -0.413, P = 0.004) and the surface area of elevated WSS (R = -0.419, P = 0.003). Multivariate linear regression analysis yielded that the height of peak WSS and the amount of elevated WSS depended individually on the presence of aortic valve stenosis and the diameter of the ascending aorta. DATA CONCLUSION The extent of increased WSS in the ascending aorta of BAV patients depends on the presence of aortic valve stenosis and aortic dilatation and is most pronounced in the presence of AS and a nondilated ascending aorta. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2018;48:522-530.
Collapse
Affiliation(s)
- Emile S. Farag
- Department of Cardiothoracic SurgeryAcademic Medical CenterAmsterdamthe Netherlands
| | - Pim van Ooij
- Department of RadiologyAcademic Medical CenterAmsterdamthe Netherlands
| | - R. Nils Planken
- Department of RadiologyAcademic Medical CenterAmsterdamthe Netherlands
| | | | - Frederiek de Heer
- Department of Cardiothoracic SurgeryAcademic Medical CenterAmsterdamthe Netherlands
| | - Berto J. Bouma
- Department of CardiologyAcademic Medical CenterAmsterdamthe Netherlands
| | | | - Maarten Groenink
- Department of RadiologyAcademic Medical CenterAmsterdamthe Netherlands
- Department of CardiologyAcademic Medical CenterAmsterdamthe Netherlands
| | - Aart J. Nederveen
- Department of RadiologyAcademic Medical CenterAmsterdamthe Netherlands
| | - Bas A.J.M. de Mol
- Department of Cardiothoracic SurgeryAcademic Medical CenterAmsterdamthe Netherlands
| | - Jolanda Kluin
- Department of Cardiothoracic SurgeryAcademic Medical CenterAmsterdamthe Netherlands
| | | |
Collapse
|
17
|
Miśkowiec D, Lipiec P, Szymczyk E, Wejner-Mik P, Michalski B, Kupczyńska K, Wierzbowska-Drabik K, Kasprzak JD. Bicuspid aortic valve morphology and its impact on aortic diameters-A systematic review with meta-analysis and meta-regression. Echocardiography 2018; 35:667-677. [PMID: 29399873 DOI: 10.1111/echo.13818] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
AIM To evaluate the impact of the 2 most common bicuspid aortic valve (BAV) morphology patterns [right-left (RL) vs right-noncoronary (RN) cusp fusion] on the aortic diameters and the impact of gender, aortic stenosis (AS), aortic regurgitation (AR), and age on the observed effects. METHODS The PubMed databases was searched up to December 31, 2016 to identify studies investigating the morphology of BAV and aortic diameters. Inclusion criteria were as follows: the data on diameter of sinuses of Valsalva (SVD) and/or ascending aorta (AAD) and BAV morphology. The additional characteristics [gender, AS and AR (% of patients with moderate or severe AS/AR) and mean age] were collected to perform a meta-regression analysis. RESULTS A total of 12 studies with 2192 patients with indexed AAD, 15 studies with 3104 patients with nonindexed AAD and 8 studies with 1271 patients with indexed SVD, and 16 studies with 3454 patients with nonindexed SVD were included. There was no difference between RL and RN group in indexed/nonindexed AAD-mean difference (MD): 0.06 mm/m2 (95% CI: -0.65 to 0.77 mm/m2 , P = .87) and -0.06 mm (95% CI: 1.10-0.97 mm, P = .91). Differently, the RL BAV was associated with larger indexed/nonindexed SVD than RN phenotype-MD: 1.66 mm/m2 (95% CI: 0.83-2.49 mm/m2 , P < .001) and 2.03 mm (95% CI: 0.97-3.09 mm, P < .001). Age, gender, AS, and AR had no influence on observed differences. CONCLUSIONS RL BAV phenotype is associated with larger SVD than RN BAV, and the observed differences are independent from aortic valve dysfunction degree, age, and gender.
Collapse
Affiliation(s)
- Dawid Miśkowiec
- Department of Cardiology, Medical University of Lodz, Lodz, Poland
| | - Piotr Lipiec
- Department of Cardiology, Medical University of Lodz, Lodz, Poland
| | - Ewa Szymczyk
- Department of Cardiology, Medical University of Lodz, Lodz, Poland
| | | | - Błażej Michalski
- Department of Cardiology, Medical University of Lodz, Lodz, Poland
| | | | | | | |
Collapse
|
18
|
Frandsen EL, Burchill LJ, Khan AM, Broberg CS. Ascending aortic size in aortic coarctation depends on aortic valve morphology: Understanding the bicuspid valve phenotype. Int J Cardiol 2018; 250:106-109. [PMID: 29169748 DOI: 10.1016/j.ijcard.2017.07.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 05/27/2017] [Accepted: 07/07/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND In roughly half of patients with coarctation of the aorta (CoA), the aorta may be enlarged. It is uncertain whether enlargement is independent of aortic valve morphology. We sought to compare aortic size in CoA with a tricuspid valve (TAV) to those with bicuspid aortic valve (BAV). METHODS Sixty-eight CoA patients and 20 healthy controls with prior cardiac magnetic resonance (CMR) imaging were included. CMR was retrospectively reanalyzed to measure aortic root and mid-ascending aorta. The maximum aortic diameter was compared between CoA with TAV, CoA with BAV, and control groups. RESULTS CoA with TAV patients (n=27) had smaller aortic root diameters than CoA with BAV (n=41) (32±4.9 vs. 37±5.8mm, p=0.001), despite being older (40 vs. 32years, p=0.01). Similarly, TAV CoA patients had a smaller mid-ascending aortic diameter (28±4.5 vs. 33±6.9mm, p=0.019) than BAV patients. TAV CoA was similar to controls in all metrics. Twenty-four patients (35%) with CoA had dilated aortas (>37mm), of which 79% had BAV. A history of hypertension did not predict larger aortic root or mid-ascending aortic dimensions. CONCLUSIONS In patients with CoA, TAV is associated with smaller aortic size compared to those with BAV, and similar to healthy controls. Aortic size in CoA is independent of hypertension. Therefore, aortopathy associated with BAV is likely a reflection of the BAV phenotype rather than CoA or its physiologic effects. This distinction may have implications for the frequency and types of monitoring and treatment of CoA patients.
Collapse
Affiliation(s)
- Erik L Frandsen
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
| | - Luke J Burchill
- Adult Congenital Heart Program, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Abigail M Khan
- Adult Congenital Heart Program, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Craig S Broberg
- Adult Congenital Heart Program, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA.
| |
Collapse
|
19
|
Sabaté-Rotés A, Sabidó Sanchez L, Gran Ipiña F, Albert Brotons D, Abella RF, Rosés Noguer F. Caracterización y factores de riesgo de dilatación aórtica en pacientes pediátricos con válvula aórtica bicúspide. Med Clin (Barc) 2017. [DOI: 10.1016/j.medcli.2017.03.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
20
|
Kong WKF, Regeer MV, Poh KK, Yip JW, van Rosendael PJ, Yeo TC, Tay E, Kamperidis V, van der Velde ET, Mertens B, Ajmone Marsan N, Delgado V, Bax JJ. Inter-ethnic differences in valve morphology, valvular dysfunction, and aortopathy between Asian and European patients with bicuspid aortic valve. Eur Heart J 2017; 39:1308-1313. [DOI: 10.1093/eurheartj/ehx562] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 09/17/2017] [Indexed: 12/22/2022] Open
Affiliation(s)
- William K F Kong
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
- Department of Cardiology, National University Heart Centre, National University Health System, 5 Lower Kent Ridge Rd, 119074 Singapore
| | - Madelien V Regeer
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Kian K Poh
- Department of Cardiology, National University Heart Centre, National University Health System, 5 Lower Kent Ridge Rd, 119074 Singapore
| | - James W Yip
- Department of Cardiology, National University Heart Centre, National University Health System, 5 Lower Kent Ridge Rd, 119074 Singapore
| | - Philippe J van Rosendael
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Tiong C Yeo
- Department of Cardiology, National University Heart Centre, National University Health System, 5 Lower Kent Ridge Rd, 119074 Singapore
| | - Edgar Tay
- Department of Cardiology, National University Heart Centre, National University Health System, 5 Lower Kent Ridge Rd, 119074 Singapore
| | - Vasileios Kamperidis
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
- Department of Cardiology, AHEPA University Hospital, St.Kiriakidis 1, PO Box 54636 Thessaloniki, Greece
| | - Enno T van der Velde
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Bart Mertens
- Medical Statistics Department, Leiden University Medical Center, Albinusdreef 2, 2300RC Leiden, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| |
Collapse
|
21
|
Bolar N, Verstraeten A, Van Laer L, Loeys B. Molecular Insights into Bicuspid Aortic Valve Development and the associated aortopathy. AIMS MOLECULAR SCIENCE 2017. [DOI: 10.3934/molsci.2017.4.478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
22
|
Mei S, de Souza Júnior FSN, Kuan MYS, Green NC, Espino DM. Hemodynamics through the congenitally bicuspid aortic valve: a computational fluid dynamics comparison of opening orifice area and leaflet orientation. Perfusion 2016; 31:683-690. [PMID: 27484972 DOI: 10.1177/0267659116656775] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A computational fluid dynamics model of a bicuspid aortic valve has been developed using idealised three-dimensional geometry. The aim was to compare how the orifice area and leaflet orientation affect the hemodynamics of a pure bicuspid valve. By applying physiologic material properties and boundary conditions, blood flow shear stresses were predicted during peak systole. A reduced orifice area altered blood velocity, the pressure drop across the valve and the wall shear stress through the valve. Bicuspid models predicted impaired blood flow similar to a stenotic valve, but the flow patterns were specific to leaflet orientation. Flow patterns developed in bicuspid aortic valves, such as helical flow, were sensitive to cusp orientation. In conclusion, the reduced opening area of a bicuspid aortic valve amplifies any impaired hemodynamics, but cusp orientation determines subsequent flow patterns which may determine the specific regions downstream from the valve most at risk of clinical complications.
Collapse
Affiliation(s)
- Sen Mei
- 1 School of Mechanical Engineering, University of Birmingham, Birmingham, UK.,2 Mechanical Engineering, Rice University, Houston, TX, USA
| | - Francisco S N de Souza Júnior
- 1 School of Mechanical Engineering, University of Birmingham, Birmingham, UK.,3 Centro de Tecnologia e Geociências, Universidade Federal de Pernambuco, Cidade Universitária Recife, Recife, Brasil
| | - May Y S Kuan
- 1 School of Mechanical Engineering, University of Birmingham, Birmingham, UK.,4 Cameron (Singapore) Pte. Ltd, Singapore
| | - Naomi C Green
- 1 School of Mechanical Engineering, University of Birmingham, Birmingham, UK
| | - Daniel M Espino
- 1 School of Mechanical Engineering, University of Birmingham, Birmingham, UK
| |
Collapse
|
23
|
Abstract
The objectives of this study were to investigate left ventricular (LV) function, aortic dilation, and atherosclerosis in children with mildly deteriorated isolated bicuspid aortic valve (BAV) function using echocardiographic studies and biochemical markers of atherosclerosis and to correlate results with normal children. Biochemical analyses indicating cardiovascular risk of atherosclerosis and vascular changes in the aorta in relation to BAV were performed in 41 children aged 5-15 years old with isolated BAV and in 25 children with tricuspid aortic valves. Evaluations of aortic valve structures and functions; examinations of the LV M-mode and ascending aorta Doppler; and measurements of the LV Tei index (MPI), propagation velocity, ascending aorta at four levels, and carotid intima-media thickness (CIMT) were performed. There were no statistically significant differences in CIMTs, plasma matrix metalloproteinase-9, tissue metalloproteinase inhibitor-1 levels, or other biochemical parameters indicating cardiovascular risk or atherosclerosis between study and control groups. Deterioration of LV function, which could not be seen with M-mode echocardiography, was evident by MPI. MPI values in the study versus control groups were 0.46 ± 0.080 versus 0.40 ± 0.086 (p < 0.05). Diameters of the aorta in the study and control groups were 19.7 ± 4.7 and 17.2 ± 2.8 mm (p < 0.05) at the sinotubular junction level and 20.6 (14.4-40.5) and 18.3 (12.4-24) mm at the ascending aorta level (p < 0.05). Increased aortic valve insufficiency was related to increased aortic diameter. No sign of atherosclerosis was detected in children with BAV. Deterioration of LV function was seen using MPI, and aortic dilation was related to the severity of aortic valve insufficiency.
Collapse
|
24
|
Affiliation(s)
- John S Ikonomidis
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC.
| |
Collapse
|
25
|
Influence of beta-blocker therapy on aortic blood flow in patients with bicuspid aortic valve. Int J Cardiovasc Imaging 2016; 32:621-8. [PMID: 26817758 DOI: 10.1007/s10554-015-0819-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 11/25/2015] [Indexed: 01/08/2023]
Abstract
In patients with bicuspid aortic valve (BAV), beta-blockers (BB) are assumed to slow ascending aorta (AAo) dilation by reducing wall shear stress (WSS) on the aneurysmal segment. The aim of this study was to assess differences in AAo peak velocity and WSS in BAV patients with and without BB therapy. BAV patients receiving BB (BB+, n = 30, age: 47 ± 11 years) or not on BB (BB-, n = 30, age: 46 ± 13 years) and healthy controls (n = 15, age: 43 ± 11 years) underwent 4D flow MRI for the assessment of in vivo aortic 3D blood flow. Peak systolic velocities and 3D WSS were calculated at the anterior and posterior walls of the AAo. Both patient groups had higher maximum and mean WSS relative to the control group (p = 0.001 to p = 0.04). WSS was not reduced in the BB+ group compared to BB- patients in the anterior AAo (maximum: 1.49 ± 0.47 vs. 1.38 ± 0.49 N/m(2), p = 0.99, mean: 0.76 ± 0.2 vs. 0.74 ± 0.18 N/m(2), p = 1.00) or posterior AAo (maximum: 1.45 ± 0.42 vs. 1.39 ± 0.58 N/m(2), p = 1.00; mean: 0.65 ± 0.16 vs. 0.63 ± 0.16 N/m(2), p = 1.00). AAo peak velocity was elevated in patients compared to controls (p < 0.01) but similar for BB+ and BB- groups (p = 0.42). Linear models identified significant relationships between aortic stenosis severity and increased maximum WSS (β = 0.186, p = 0.007) and between diameter at the sinus of Valsalva and reduced mean WSS (β = -0.151, p = 0.045). Peak velocity and systolic WSS were similar for BAV patients irrespective of BB therapy. Further prospective studies are needed to investigate the impact of dosage and duration of BB therapy on aortic hemodynamics and development of aortopathy.
Collapse
|
26
|
Li M, Qi RD, Zhu JM, Liu YM, Zheng J, Sun LZ. One-Stage Repair of Acute Type B Dissection With Ascending Thoracic Aortic Dilatation Using a Stented Elephant Trunk Procedure. J Card Surg 2015; 30:756-60. [PMID: 26333312 DOI: 10.1111/jocs.12616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Acute type B dissection with ascending thoracic aortic dilatation (ATAD) is very common, but remains surgically challenging with the use of the conventional single-stage procedure via median sternotomy or lateral thoracotomy. We report our experience with repair of acute type B dissection with ATAD using a one-stage stented elephant trunk procedure. METHODS We retrospectively reviewed the medical records of 16 patients (13 males and 3 females) with acute type B dissection with ATAD who underwent ascending thoracic aortic reconstruction combined with a stented elephant trunk procedure under hypothermic cardiopulmonary bypass with selective antegrade cerebral perfusion between February 2009 and February 2013. ATAD included ascending aortic aneurysm in four patients, ascending aortic enlargement + aortic regurgitation in three, and ascending aortic aneurysm + aortic root aneurysm in nine. Lower limb ischemia occurred in one case. RESULTS There was no in-hospital mortality. Drainage of the pericardial sac was indicated for two patients with pericardial effusion. The median durations of ventilator support and intensive care unit stay were 25 ± 18 and 48 ± 7 hours, respectively. Lower limber ischemia was alleviated after implantation of a stented elephant trunk. One patient received thoracoabdominal aortic replacement during follow-up and encountered no postoperative complications. CONCLUSIONS Satisfactory surgical results and follow-up outcomes can be achieved using the proposed one-stage stented elephant trunk procedure for acute type B dissection with ATAD.
Collapse
Affiliation(s)
- Ming Li
- Department of Cardiothoracic Surgery, Affiliated Zhuhai Hospital of Jinan University, Guangdong, Zhuhai, China.,Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases & Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Rui-Dong Qi
- Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases & Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jun-Ming Zhu
- Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases & Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yong-Min Liu
- Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases & Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jun Zheng
- Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases & Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Li-Zhong Sun
- Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases & Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
27
|
Merlanti B, De Chiara B, Maggioni AP, Moreo A, Pileggi S, Romeo G, Russo CF, Rizzo S, Martinelli L, Maseri A. Rationale and design of GISSI OUTLIERS VAR Study in bicuspid aortic valve patients: prospective longitudinal, multicenter study to investigate correlation between surgical, echo distinctive features, histologic and genetic findings in phenotypically homogeneous outlier cases. Int J Cardiol 2015. [PMID: 26197404 DOI: 10.1016/j.ijcard.2015.06.182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND/OBJECTIVES Bicuspid aortic valve (BAV) is the most common congenital heart disorder, affecting up to 2% of the population. Involvement of aortic root and ascending aorta (aneurysm or, eventually, dissection) is frequent in patients with pathologic or normal functioning BAV. Unfortunately, there are no well-known correlations between valvular and vascular diseases. In VAR protocol, with a new strategy of research, we analysemultiple aspects of BAV disease through correlation between surgical, echo, histologic and genetic findings in phenotypically homogeneous outlier cases. METHODS VAR protocol is a prospective, longitudinal, multicenter study. It observes 4 homogeneous small groups of BAV surgical patients (15 patients each): isolated aortic regurgitation, isolated ascending aortic aneurysm, aortic regurgitation associated with aortic aneurysm, isolated aortic stenosis in older patients (>60years). Echo analysis is extended to first-degree relatives and, in case of BAV, genetic test is performed. Patients and relatives are enrolled in 10 cardiac surgery/cardiologic centers throughout Italy. CONCLUSIONS The aim of the study is to identify predictors of favorable or unfavorable evolution of BAV in terms of valvular dysfunction and/or aortic aneurysm. Correlations between different features could help in identification of various BAV risk groups, rationalizing follow-up and treatment.
Collapse
Affiliation(s)
- Bruno Merlanti
- S.C. Cardiochirurgia, Department of Cardiology and Cardiovascular Surgery, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Benedetta De Chiara
- S.C. Cardiologia IV, Department of Cardiology and Cardiovascular Surgery, Niguarda Ca' Granda Hospital, Milan, Italy
| | | | - Antonella Moreo
- S.C. Cardiologia IV, Department of Cardiology and Cardiovascular Surgery, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Silvana Pileggi
- Department of Cardiovascular Research, IRCCS Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Gabriella Romeo
- Department of Cardiac, Vascular and Thoracic Sciences, University of Padua, Padua, Italy
| | - Claudio Francesco Russo
- S.C. Cardiochirurgia, Department of Cardiology and Cardiovascular Surgery, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Stefania Rizzo
- Cardiovascular Pathology, Department of Cardiological, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Luigi Martinelli
- Cardiothoracic Surgery, ICLAS-Istituto Clinico Ligure Alta Specialità, Rapallo, Italy
| | | | | |
Collapse
|
28
|
Hernández CE, Valera FJ, Doñate L, Schuler M, Berbel A, Bel AM, Perez M, Heredia T, Vazquez A, Torregrosa S, Montero JA. La morfología y la lesión predominante de la válvula aórtica bicúspide determinan el patrón de aortopatía. CIRUGIA CARDIOVASCULAR 2015. [DOI: 10.1016/j.circv.2014.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
29
|
Porras C, Sánchez-Espín G. Válvula áortica bicúspide y aortopatía. Una asociación llena de incógnitas. CIRUGIA CARDIOVASCULAR 2015. [DOI: 10.1016/j.circv.2015.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
30
|
Stephens EH, Hope TA, Kari FA, Kvitting JPE, Liang DH, Herfkens RJ, Miller DC. Greater asymmetric wall shear stress in Sievers' type 1/LR compared with 0/LAT bicuspid aortic valves after valve-sparing aortic root replacement. J Thorac Cardiovasc Surg 2015; 150:59-68. [DOI: 10.1016/j.jtcvs.2015.04.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 03/31/2015] [Accepted: 04/07/2015] [Indexed: 11/16/2022]
|
31
|
Furukawa H, Tanemoto K. Current topics on bicuspid aortic valve: clinical aspects and surgical management. Ann Thorac Cardiovasc Surg 2015; 21:314-21. [PMID: 26095042 DOI: 10.5761/atcs.ra.15-00130] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Bicuspid aortic valve (BAV) has been identified as the most common heart valve anomaly and is considered to be a heritable disorder that affects various cardiovascular disorders, including aortopathy. Current topics regarding the clinical management of BAV including surgical strategies with or without concomitant aortic repair or replacement are attracting interest, in addition to the pathological and morphological aspects of BAV as well as aortopathy. However, surgical indications are still being debated and are dependent on current clinical guidelines and surgeons' preferences. Although clinical guidelines have already been established for the management of BAV with or without aortopathy, many studies on clinical management and surgical techniques involving various kinds of subjects have previously been published. Although a large number of studies concerning the clinical aspects of BAV have been reviewed in detail, controversy still surrounds the clinical and surgical management of BAV. Therefore, surgeons should carefully consider valve pathology when deciding whether to replace the ascending aorta. In this review, we summarized current topics on BAV and the surgical management of diseased BAV with or without aortopathy based on previous findings, including catheter-based interventional management.
Collapse
Affiliation(s)
- Hiroshi Furukawa
- Department of Cardiovascular Surgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | | |
Collapse
|
32
|
Ruzmetov M, Shah JJ, Fortuna RS, Welke KF. The Association Between Aortic Valve Leaflet Morphology and Patterns of Aortic Dilation in Patients With Bicuspid Aortic Valves. Ann Thorac Surg 2015; 99:2101-7; discussion 2107-8. [PMID: 25921253 DOI: 10.1016/j.athoracsur.2015.02.036] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 01/30/2015] [Accepted: 02/12/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND Dilation of the aorta is a frequent complication in patients with bicuspid aortic valves. The aim of this study was to determine the relationship between the subtype of leaflet fusion, right and noncoronary leaflet (R/N) fusion versus right and left leaflet (R/L) fusion, and the patterns of aortic dilation and valve dysfunction in young patients with bicuspid aortic valves. METHODS We performed a retrospective review of 642 patients who presented with bicuspid aortic valves between 1994 and 2014. Of these patients, 210 (33%) had aortic dilation (z score >3) by echocardiogram. For each patient, the most recent study or the last study before intervention was reviewed. RESULTS Median patient age was 15 years (range, 0 to 40 years) with patients with R/N fusion being younger. The most prevalent subtype was R/N fusion (R/N, n = 114, 54% versus R/L, n = 96, 46%). Dilation of the ascending aorta was seen more often in patients with R/N fusion (R/N, 88% versus R/L, 68%; p = 0.004), whereas the prevalence of dilation of the sinuses of Valsalva was significantly higher in patients with R/L fusion (R/L, 46% versus R/N, 20%; p = 0.01). The magnitude of dilation differed as well. The z value of the sinuses of Valsalva was significantly higher in patients with R/L fusion (R/L, 2.03 versus R/N, 1.2; p = 0.003), whereas the z values of the ascending aorta and sinotubular junction were similar between the groups. Patients with R/N fusion were more likely to have aortic stenosis, and within the R/N group, patients with aortic insufficiency had a greater degree of ascending aorta dilation (p = 0.04). CONCLUSIONS Our study suggests that in young patients with bicuspid aortic valves and aortic dilation, aortic valve morphology may be associated with the patterns of aortic dilation and valve dysfunction. Patients with R/N fusion were more likely to have ascending aorta dilation, whereas patients with R/L fusion were more likely to have dilation of the aortic root. In addition, patients with R/N fusion presented at a younger age and were more likely to have aortic stenosis. Recognition of these differences may eventually be helpful for patient counseling and the planning of follow-up.
Collapse
Affiliation(s)
- Mark Ruzmetov
- Section of Pediatric Cardiovascular Surgery and Pediatric Cardiology, University of Illinois College of Medicine at Peoria, Children's Hospital of Illinois, OSF Saint Francis Medical Center, Peoria, Illinois
| | - Jitendra J Shah
- Section of Pediatric Cardiovascular Surgery and Pediatric Cardiology, University of Illinois College of Medicine at Peoria, Children's Hospital of Illinois, OSF Saint Francis Medical Center, Peoria, Illinois
| | - Randall S Fortuna
- Section of Pediatric Cardiovascular Surgery and Pediatric Cardiology, University of Illinois College of Medicine at Peoria, Children's Hospital of Illinois, OSF Saint Francis Medical Center, Peoria, Illinois
| | - Karl F Welke
- Section of Pediatric Cardiovascular Surgery and Pediatric Cardiology, University of Illinois College of Medicine at Peoria, Children's Hospital of Illinois, OSF Saint Francis Medical Center, Peoria, Illinois.
| |
Collapse
|
33
|
Marin A, Weir-McCall JR, Webb DJ, van Beek EJR, Mirsadraee S. Imaging of cardiovascular risk in patients with Turner's syndrome. Clin Radiol 2015; 70:803-14. [PMID: 25917542 PMCID: PMC4509713 DOI: 10.1016/j.crad.2015.03.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 02/17/2015] [Accepted: 03/19/2015] [Indexed: 01/14/2023]
Abstract
Turner's syndrome is a disorder defined by an absent or structurally abnormal second X chromosome and affects around 1 in 2000 newborn females. The standardised mortality ratio in Turner's syndrome is around three-times higher than in the general female population, mainly as a result of cardiovascular disorders. Most striking is the early age at which Turner's syndrome patients develop the life-threatening complications of cardiovascular disorders compared to the general population. The cardiovascular risk stratification in Turner's syndrome is challenging and imaging is not systematically used. The aim of this article is to review cardiovascular risks in this group of patients and discuss a systematic imaging approach for early identification of cardiovascular disorders in these patients.
Collapse
Affiliation(s)
- A Marin
- Clinical Research Imaging Centre, Queen's Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - J R Weir-McCall
- Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital & Medical School, Dundee DD1 9SY, UK
| | - D J Webb
- Queen's Medical Research Institute, University of Edinburgh/BHF Centre for Cardiovascular Science, Edinburgh EH16 4TJ, UK
| | - E J R van Beek
- Clinical Research Imaging Centre, Queen's Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - S Mirsadraee
- Clinical Research Imaging Centre, Queen's Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, UK.
| |
Collapse
|
34
|
Characteristics of aortic valve dysfunction and ascending aorta dimensions according to bicuspid aortic valve morphology. Eur Radiol 2015; 25:2103-14. [DOI: 10.1007/s00330-014-3585-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 11/19/2014] [Accepted: 12/22/2014] [Indexed: 10/24/2022]
|
35
|
Kari F, Beyersdorf F. Bikuspidale Aortenklappe. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2014. [DOI: 10.1007/s00398-014-1117-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
36
|
Abstract
Outpatient management of patients with structurally or functionally abnormal cardiac valves combines an ability to record an appropriate history, a directed physical examination, a knowledge of both the interpretation as well as the context of any associated testing, and an understanding of the care guidelines in the medical literature. This article attempts to integrate these various features to guide the clinician towards more appropriate and timely management of patients with cardiac valve disease.
Collapse
|
37
|
Review of Molecular and Mechanical Interactions in the Aortic Valve and Aorta: Implications for the Shared Pathogenesis of Aortic Valve Disease and Aortopathy. J Cardiovasc Transl Res 2014; 7:823-46. [DOI: 10.1007/s12265-014-9602-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 10/30/2014] [Indexed: 01/08/2023]
|
38
|
Benedik J, Dohle DS, Wendt D, Pilarczyk K, Price V, Mourad F, Zykina E, Stebner F, Tsagakis K, Jakob H. Comparison of ascending aortic cohesion between patients with bicuspid aortic valve stenosis and regurgitation. Eur J Cardiothorac Surg 2014; 46:e89-93. [DOI: 10.1093/ejcts/ezu358] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
|
39
|
Grewal N, Gittenberger-de Groot AC, DeRuiter MC, Klautz RJM, Poelmann RE, Duim S, Lindeman JHN, Koenraadt WMC, Jongbloed MRM, Mohamed SA, Sievers HH, Bogers AJJC, Goumans MJ. Bicuspid aortic valve: phosphorylation of c-Kit and downstream targets are prognostic for future aortopathy. Eur J Cardiothorac Surg 2014; 46:831-9. [PMID: 25161185 DOI: 10.1093/ejcts/ezu319] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The clinical course of many patients with a bicuspid aortic valve (BAV) is complicated by ascending aortic dilatation. Currently, the indication for aortic surgery is solely based on the aortic diameter and subsequently only a small proportion of BAV patients undergoing valve surgery require concomitant ascending aortic replacement based on these recommendations. Unfortunately, a substantial number of BAV patients still develop aortic dilatation in the future and would potentially benefit from a more aggressive approach towards ascending aortic replacement. We, therefore, designed this study to identify molecular biological markers in the aortic wall predictive of aortopathy in BAV. METHODS Ascending aortic wall specimen of BAV (n = 36) and tricuspid aortic valve (TAV) (n = 23), both without and with (>44 mm) dilatation were investigated histologically and immunohistochemically for the expression of markers for vascular remodelling [transforming growth factor (TGF)-β, phosphorylated Smad2, matrix metalloproteinase 9 (MMP9)], cellular differentiation [c-Kit, phosphorylated-c-Kit, hypoxia-inducable factor-1 alpha (HIF1α)] and haemodynamic influences on the aortic wall [endothelial nitric oxide (eNOS)]. RESULTS All BAV patients showed significantly less inflammation (P < 0.001) and an altered intima/media ratio when compared with TAV patients. The expression of markers of a signalling pathway characteristic for cellular dedifferentiation, as exemplified by the marked expression of c-Kit, phosphorylated c-Kit and HIF1α; in the dilated BAV group was however completely comparable with only a subgroup of the non-dilated BAV (BAb), whereas the remainder of the non-dilated BAV group (BAa) was significantly distinct. This difference between the dilated BAV and BAa was further confirmed in the expression of TGF-β, phosphorylated Smad2, MMP9 and eNOS. Besides the expression pattern, similarity in the dilated BAV and BAb was also noted clinically in the most common variant of commissure position and conjoined raphe of the BAV. Based on these observations, we consider the BAb group a likely candidate for future dilatation as opposed to the BAa group. CONCLUSIONS Using a panel of molecular tissue markers, the non-dilated BAV patients can be divided into groups susceptible and non-susceptible to aortopathy.
Collapse
Affiliation(s)
- Nimrat Grewal
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Marco C DeRuiter
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands
| | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Robert E Poelmann
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands
| | - Sjoerd Duim
- Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, Netherlands
| | - Johannes H N Lindeman
- Department of Vascular Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Wilke M C Koenraadt
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Monique R M Jongbloed
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Salah A Mohamed
- Department of Cardiac and Thoracic Vascular Surgery, University of Lübeck, Lübeck, Germany
| | - Hans-Hinrich Sievers
- Department of Cardiac and Thoracic Vascular Surgery, University of Lübeck, Lübeck, Germany
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery and Heart Valve Bank, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Marie-José Goumans
- Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, Netherlands
| |
Collapse
|
40
|
Affiliation(s)
- Subodh Verma
- From the Division of Cardiac Surgery, St. Michael's Hospital, Department of Surgery, University of Toronto, Toronto (S.V.), and the Division of Cardiology, Department of Medicine, Lawson Research Institute, London Health Sciences Centre, Western University, London, ON (S.C.S.) - both in Canada
| | | |
Collapse
|
41
|
Moaref A, Khavanin M, Shekarforoush S. Aortic distensibility in bicuspid aortic valve patients with normal aortic diameter. Ther Adv Cardiovasc Dis 2014; 8:128-132. [DOI: 10.1177/1753944714531062] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: Bicuspid aortic valve (BAV) is associated with aortic abnormalities. The ascending aorta tends to dilate and its elasticity deteriorates. The morphology of the BAV and the elasticity of the proximal ascending aorta seem to influence the outcome. This study aimed to determine the distensibility of the ascending aorta with normal diameter in BAV patients and its relation to its morphology. Methods: This is a cross-sectional study. In the patients with BAV referred for echocardiography, the phenotype was defined as anteroposterior (AP) or mediolateral (ML) leaflet orientations. The aortic distensibility at 5–10 mm above the sinotubular junction was assessed using transthoracic echocardiography in 50 BAV patients, and 50 healthy controls with tricuspid aortic valve (TAV) matched by gender and age. Results: The ascending aorta in BAV patients had less distensibility compared with that in the control subjects (0.00298 ± 0.0023 versus 0.00805 ± 0.0028 cm2 dynes−1 × 10−6, respectively, p < 0.001). The ML phenotype of BAVs was more frequent. However, the reduced distensibility was not related to gender and morphology of the valve. Conclusions: Regardless of the valve morphology and also in the absence of aortic dilation, aortic distensibility is impaired in BAV subjects compared with TAV subjects. This finding supports the idea of an intrinsic aortic wall anomalies underlying the impaired elasticity of the aorta in BAV patients.
Collapse
Affiliation(s)
- Alireza Moaref
- Cardiovascular Research Center, Shahid Faghihi Hospital, Zand Ave., Shiraz 7134844119, Iran
| | - Mohammad Khavanin
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | | |
Collapse
|
42
|
Stefani L, Galanti G, Innocenti G, Mercuri R, Maffulli N. Exercise training in athletes with bicuspid aortic valve does not result in increased dimensions and impaired performance of the left ventricle. Cardiol Res Pract 2014; 2014:238694. [PMID: 24600528 PMCID: PMC3926276 DOI: 10.1155/2014/238694] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 12/17/2013] [Accepted: 12/19/2013] [Indexed: 11/17/2022] Open
Abstract
Background. Bicuspid aortic valve (BAV) is one of the most common congenital heart disease (0.9%-2%) and is frequently found in the athletes and in the general population. BAV can lead to aortic valve dysfunction and to a progressive aortic dilatation. Trained BAV athletes exhibit a progressive enlargement of the left ventricle (LV) compared to athletes with normal aortic valve morphology. The present study investigates the possible relationship between different aortic valve morphology and LV dimensions. Methods. In the period from 2000 to 2011, we investigated a total of 292 BAV subjects, divided into three different groups (210 athletes, 59 sedentaries, and 23 ex-athletes). A 2D echocardiogram exam to classify BAV morphology and measure the standard LV systo-diastolic parameters was performed. The study was conducted as a 5-year follow-up echocardiographic longitudinal and as cross-sectional study. Results. Typical BAV was more frequent in all three groups (68% athletes, 67% sedentaries, and 63% ex-athletes) than atypical. In BAV athletes, the typical form was found in 51% (107/210) of soccer players, 10% (21/210) of basketball players, 10% track and field athletics (20/210), 8% (17/210) of cyclists, 6% (13/210) swimmers, and 15% (32/210) of rugby players and others sport. Despite a progressive enlargement of the LV (P < 0.001) observed during the follow-up study, no statistical differences of the LV morphology and function were evident among the diverse BAV patterns either in sedentary subjects or in athletes. Conclusion. In a large population of trained BAV athletes, with different prevalence of typical and atypical BAV type, there is a progressive nonstatistically significant enlargement of the LV. In any case, the dimensions of the LV remained within normal range. The metabolic requirements of the diverse sport examined in the present investigations do not seem to produce any negative impact in BAV athletes.
Collapse
Affiliation(s)
- Laura Stefani
- Sport Medicine Center, University of Florence, Viale Morgagni 45, Florence, Italy
| | - Giorgio Galanti
- Sport Medicine Center, University of Florence, Viale Morgagni 45, Florence, Italy
| | - Gabriele Innocenti
- Sport Medicine Center, University of Florence, Viale Morgagni 45, Florence, Italy
| | - Roberto Mercuri
- Sport Medicine Center, University of Florence, Viale Morgagni 45, Florence, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy
- William Harvey Institute, Centre for Sports and Exercise, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK
| |
Collapse
|
43
|
Girdauskas E, Rouman M, Disha K, Scholle T, Fey B, Theis B, Petersen I, Borger MA, Kuntze T. Correlation between systolic transvalvular flow and proximal aortic wall changes in bicuspid aortic valve stenosis. Eur J Cardiothorac Surg 2014; 46:234-9; discussion 239. [PMID: 24431167 DOI: 10.1093/ejcts/ezt610] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES The purpose of this study was to analyse the correlation between preoperative systolic transvalvular flow patterns and proximal aortic wall lesions in patients undergoing surgery for bicuspid aortic valve (BAV) stenosis. METHODS A total of 48 consecutive patients with BAV stenosis (mean age 58 ± 9 years, 65% male) underwent aortic valve replacement (AVR) ± proximal aortic surgery from January 2012 through February 2013. Preoperative cardiac phase-contrast cine magnetic resonance imaging (MRI) assessment was performed in all patients in order to detect the area of maximal flow-induced stress in the proximal aorta. Based on these MRI data, two aortic wall samples (i.e. area of the maximal stress (jet sample) and the opposite aortic wall (control sample)) were collected during AVR surgery. Aortic wall changes were graded based on a summation of seven histological criteria (each scored from 0 to 3). Histological sum score (0-21) was separately calculated and compared between the two aortic samples (i.e. jet sample vs control sample). RESULTS An eccentric transvalvular flow jet hitting the proximal aortic wall could be identified in all 48 (100%) patients. The mean histological sum score was significantly higher in the jet sample vs control sample areas of the aorta (i.e. 4.1 ± 1.8 vs 2.2 ± 1.5, respectively) (P = 0.02). None of the patients had a higher sum score value in the control sample. CONCLUSIONS Our study demonstrates a strong correlation between the systolic pattern of the transvalvular flow jet and asymmetric proximal aortic wall changes in patients undergoing AVR for BAV stenosis.
Collapse
Affiliation(s)
- Evaldas Girdauskas
- Department of Cardiac Surgery, Central Clinic Bad Berka, Bad Berka, Germany
| | - Mina Rouman
- Department of Cardiac Surgery, Central Clinic Bad Berka, Bad Berka, Germany
| | - Kushtrim Disha
- Department of Cardiac Surgery, Central Clinic Bad Berka, Bad Berka, Germany
| | - Thorsten Scholle
- Department of Radiology, Central Clinic Bad Berka, Bad Berka, Germany
| | - Beatrix Fey
- Department of Radiology, Central Clinic Bad Berka, Bad Berka, Germany
| | - Bernhard Theis
- Institute of Pathology, Friedrich-Schiller University Jena, Jena, Germany
| | - Iver Petersen
- Institute of Pathology, Friedrich-Schiller University Jena, Jena, Germany
| | - Michael A Borger
- Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Thomas Kuntze
- Department of Cardiac Surgery, Central Clinic Bad Berka, Bad Berka, Germany
| |
Collapse
|
44
|
Della Corte A, Bancone C, Dialetto G, Covino FE, Manduca S, D'Oria V, Petrone G, De Feo M, Nappi G. Towards an individualized approach to bicuspid aortopathy: different valve types have unique determinants of aortic dilatation. Eur J Cardiothorac Surg 2014; 45:e118-24; discussion e124. [PMID: 24420369 DOI: 10.1093/ejcts/ezt601] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Bicuspid aortic valve (BAV)-related aortopathy is increasingly recognized to be a heterogeneous disease entity, although the surgical approach, from indications to techniques, is still standard rather than individualized. We aimed to define the determinants of aortic dilatation in BAV patients stratified according to the valve morphotype. METHODS A consecutive echocardiographic series of 622 BAV patients was analysed. Among demographic (age, sex), anthropometric (height, weight, body surface area, body mass index), clinical (associated diseases) and echocardiographic variables (valve function, ventricular parameters), the determinants of aortic root and ascending tract diameter were assessed by multivariate regression models, as well as the predictors of aortic dilatation (size index >2.1 cm/m(2)) both in the overall population and separately in groups of different valve morphotypes (RL, right-left fusion; RN, right-non-coronary fusion). RESULTS Independent determinants of aortic root diameter (at sinuses) were age (P < 0.001), significant aortic regurgitation (P < 0.001), sex (female protective, P < 0.001) and valve morphotype (RN protective, P < 0.001). Independent determinants of ascending aortic diameter (tubular tract) were age (P < 0.001), RN morphotype (P < 0.001), body mass index (P = 0.005) and chronic obstructive pulmonary disease (P < 0.001). In univariate analysis, the RL morphotype was associated with dilatation (ASI > 2.1 cm/m(2)) at sinuses in 41% cases vs 22% for RN (P < 0.001), and the RN morphotype was associated with dilatation at the tubular tract in 68 vs 56% for RL (P = 0.007). The presence of root dilatation was predicted by age and absence of significant stenosis in the RL morphotype subgroup, and by severe regurgitation in the RN subgroup. In the RL-type subgroup, non-regurgitant aortic valve and chronic lung disease predicted dilatation at the ascending level; and in the RN-type subgroup, age and obesity. CONCLUSIONS The two most common BAV morphotypes are associated with aortic dilatation at two different tracts (RL at the root; RN at the tubular ascending tract) independently of valve function. Moreover, the determinants of aortic dilatation were at least in part different between the two morphotypes: this may provide stratification criteria for individualized methods of follow-up and treatment.
Collapse
Affiliation(s)
- Alessandro Della Corte
- Department of Cardiothoracic Sciences, Second University of Naples, c/o V. Monaldi Hospital, Naples, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Thomas J, Yetman AT. Management of cardiovascular disease in Turner syndrome. Expert Rev Cardiovasc Ther 2014; 7:1631-41. [DOI: 10.1586/erc.09.149] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
46
|
Girdauskas E, Disha K, Borger MA, Kuntze T. Long-term prognosis of ascending aortic aneurysm after aortic valve replacement for bicuspid versus tricuspid aortic valve stenosis. J Thorac Cardiovasc Surg 2014; 147:276-82. [DOI: 10.1016/j.jtcvs.2012.11.004] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 10/05/2012] [Accepted: 11/06/2012] [Indexed: 11/16/2022]
|
47
|
Factors affecting a dilated ascending aorta in patients with bicuspid aortic valve: the relevance of valve anatomy, body size and age. Surg Today 2013; 44:1483-9. [PMID: 24306212 DOI: 10.1007/s00595-013-0798-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 08/05/2013] [Indexed: 01/15/2023]
Abstract
PURPOSE Information regarding the appropriate management of patients with moderately dilated ascending aortas is limited. We investigated factors affecting ascending aortic dilatation in BAV patients, such as anatomy, body size and age. METHODS We evaluated 130 patients with BAV (age, 59.9 ± 16.1 years; body surface area (BSA), 1.58 ± 0.20 m(2)) who underwent aortic valve surgery. The cusp configuration was determined according to the presence and location of the raphe and the cusp direction. The ascending aortic diameter index (AADI) was calculated using computed tomography and the BSA. RESULTS Sixty-four patients had A-P-type BAV, while 66 had R-L-type BAV. The mean ascending aorta diameter was 42.6 ± 6.7 mm, and the mean AADI was 27.1 ± 5.6 mm/m(2). Based on the AADI, cusp configuration (R-L-BAV: 28.3 ± 6.0 mm/m(2) vs. A-P-BAV 25.8 ± 4.9 mm/m(2), P < 0.05), a female gender, age and the presence of aortic stenosis were found to be related to ascending aortic dilatation, while the mean ascending aortic diameter did not differ between the groups. Among the elderly patients, an AADI greater than 28 mm/m(2) was more frequently observed in the R-L-BAV group than in the A-P-BAV group. Ascending aortic replacement was required after 10 years in two patients with R-L-BAV and no patients with A-P-BAV. CONCLUSIONS The relative ascending aortic diameter helped to identify patients with BAV with a risk of dilatation, indicating that the use of ascending aortic replacement should be considered more frequently in patients with R-L-type BAV, while the procedure is avoidable in elderly patients with A-P-type BAV.
Collapse
|
48
|
Page DE, Newcomb A. Aortic wall destruction associated with a rare 11.5-cm ascending aortic aneurysm. ANZ J Surg 2013; 85:585-7. [PMID: 24286125 DOI: 10.1111/ans.12469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Dean E Page
- Cardiothoracic Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Andrew Newcomb
- Cardiothoracic Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
49
|
Merritt BA, Turin A, Markl M, Malaisrie SC, McCarthy PM, Carr JC. Association between leaflet fusion pattern and thoracic aorta morphology in patients with bicuspid aortic valve. J Magn Reson Imaging 2013; 40:294-300. [PMID: 24924661 DOI: 10.1002/jmri.24376] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 08/05/2013] [Indexed: 01/15/2023] Open
Abstract
PURPOSE To determine if patients with certain bicuspid aortic valve (BAV) phenotypes are predisposed to particular morphological abnormalities of the thoracic aorta. MATERIALS AND METHODS One hundred ninety-two patients with BAV who underwent magnetic resonance angiography between January 2007 and July 2010 were retrospectively identified. Aortic morphology was examined through measurements of aortic size index at nine levels along the thoracic aorta, three-dimensional volume of the ascending aorta, vessel asymmetry, and assessment of aortic root morphology. RESULTS We found 140 patients (73%) with right and left coronary cusps (R-L) fusion, 46 patients (24%) with R-N fusion, and 6 patients (3%) with left and noncoronary cusps (L-N) fusion. Mean aortic volume in the proximal ascending aorta was significantly greater in R-L patients (0.93 versus 0.60 cm(3)/m(2); P < 0.01). R-N patients possessed greater aortic size index at the distal ascending aorta and proximal aortic arch, and were also significantly more likely to have Type 2 patterns of aortic dilatation. CONCLUSION Our results suggest that BAV with R-L fusion is associated with increased dimensions of the aortic root, while BAV with R-N fusion is associated with increased dimensions of the distal ascending aorta and proximal arch. Our findings illustrate the morphological heterogeneity that exists among BAV phenotypes.
Collapse
Affiliation(s)
- Bryce A Merritt
- Northwestern University, Feinberg School of Medicine, Department of Radiology, Chicago, Illinois, USA
| | | | | | | | | | | |
Collapse
|
50
|
Nardi P, Pellegrino A, Russo M, Saitto G, Bertoldo F, Chiariello L. Midterm Results of Different Surgical Techniques to Replace Dilated Ascending Aorta Associated With Bicuspid Aortic Valve Disease. Ann Thorac Surg 2013; 96:1648-54. [DOI: 10.1016/j.athoracsur.2013.06.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 06/05/2013] [Accepted: 06/07/2013] [Indexed: 11/28/2022]
|