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Sopek Merkaš I, Lakušić N, Predrijevac M, Štambuk K, Hrabak Paar M. Bicuspid aortic valve with associated aortopathy, significant left ventricular hypertrophy or concomitant hypertrophic cardiomyopathy: A diagnostic and therapeutic challenge. World J Clin Cases 2023; 11:4251-4257. [PMID: 37449224 PMCID: PMC10336990 DOI: 10.12998/wjcc.v11.i18.4251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/19/2023] [Accepted: 05/24/2023] [Indexed: 06/26/2023] Open
Abstract
Due to its prevalence of 0.5% to 2% in the general population, with a 75% predominance among men, bicuspid aortic valve is the most common congenital heart defect. It is frequently accompanied by other cardiac congenital anomalies, and clinical presentation can vary significantly, with stenosis being the most common manifestation, often resulting in mild to moderate concentric hypertrophy of the left ventricle. Echocardiography is the primary diagnostic modality utilized for establishing the diagnosis, and it is often the sole diagnostic tool relied upon by clinicians. However, due to the heterogeneous clinical presentation and possible associated anomalies (which are often overlooked in clinical practice), it is necessary to employ various diagnostic methods and persist in finding the accurate diagnosis if multiple inconsistencies exist. By employing this approach, we can effectively manage these patients and provide them with appropriate treatment. Through a clinical case from our practice, we provide an overview of the literature on bicuspid aortic valve with aortophaty and the possible association with hypertrophic cardiomyopathy, diagnostic methods, and treatment options. This review article highlights the critical significance of achieving an accurate diagnosis in patients with bicuspid aortic valve and significant left ventricular hypertrophy. It is crucial to exclude other possible causes of left ventricular outflow tract obstruction, such as sub- or supra-aortic obstructions, and hypertrophic cardiomyopathy.
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Affiliation(s)
- Ivana Sopek Merkaš
- Department of Cardiology, Special Hospital for Medical Rehabilitation Krapinske Toplice, Krapinske Toplice 49217, Croatia
| | - Nenad Lakušić
- Department of Cardiology, Special Hospital for Medical Rehabilitation Krapinske Toplice, Krapinske Toplice 49217, Croatia
- Department of Clinical Medicine, Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia
- Department of Internal Medicine, Family Medicine and History of Medicine, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia
| | - Mladen Predrijevac
- Department of Cardiovascular Surgery, Magdalena Clinic for Cardiovascular Diseases, Krapinske Toplice 49217, Croatia
| | - Krešimir Štambuk
- Department of Clinical Medicine, Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia
- Department of Cardiology, Magdalena Clinic for Cardiovascular Diseases, Krapinske Toplice 49217, Croatia
| | - Maja Hrabak Paar
- Department of Diagnostic and Interventional Radiology, University Hospital Centre Zagreb, Zagreb 10000, Croatia
- School of Medicine, University of Zagreb, Zagreb 10000, Croatia
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Yu S, Guo X, Li G, Yang H, Zheng L, Sun Y. Gender discrepancy in the predictive effect of aortic root diameter on incidence of cardiovascular events among rural Northeast Chinese. BMJ Open 2022; 12:e039207. [PMID: 36691125 PMCID: PMC9454021 DOI: 10.1136/bmjopen-2020-039207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 12/28/2020] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES The possible predictive effect of echocardiographic aortic root diameter (ARD) on the incidence of cardiovascular events (CVEs) in a large, general population is limited. In addition, there is a lack of data about rural participants. We intend to figure out the possible relationship between ARD and the incidence of CVEs among the general population from rural China. DESIGN Population-based cohort study. SETTING Rural areas in Liaoning Province, Northeast China. PARTICIPANTS At baseline, 9810 participants (mean age 53±10, 49.1% male) were enrolled in the Northeast China Rural Cardiovascular Health Study between 2012 and 2017. MAIN OUTCOME MEASURES Cardiac ultrasonography, lifestyle, medical history, laboratory testing, blood pressure, weight and height. ARD measurement was conducted at the level of the sinuses of Valsalva. Furthermore, the ARD was indexed to height or body surface area. RESULTS During a median follow-up of 4.66 years, 550 non-fatal or fatal CVEs were recorded. Adjusting for blood pressure, age, total cholesterol, fasting blood glucose, estimated glomerular filtration rate, current smoking and drinking, previous cardiovascular diseases and antihypertensive treatment; ARD/height (HR per 1-unit increase=1.781, 95% CI: 1.160 to 2.736, p=0.008) was associated with an increased risk of CVEs in men only. The combination of left ventricular hypertrophy (LVH) and aortic dilation was an independent and powerful predictor for cardiovascular prognosis compared with aortic dilation alone in men but not in women. CONCLUSIONS Our study enrols a large sample of rural Chinese residents, and first confirms that ARD/height has a predictive effect on the incidence of CVEs among rural Chinese residents. The combination of LVH and aortic dilation is synergistic, which increases its predictive effect on CVEs in men only, suggesting that aortic dilatation predicts cardiovascular prognosis better than LVH does in men but not in women.
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Affiliation(s)
- Shasha Yu
- Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xiaofan Guo
- The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Guangxiao Li
- Clinical Epidemiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Hongmei Yang
- Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Liqiang Zheng
- Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yingxian Sun
- The First Hospital of China Medical University, Shenyang, Liaoning, China
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Minatoya K. Is this the final answer for the aortopathy with bicuspid aortic valve. J Card Surg 2022; 37:2336-2337. [PMID: 35526124 DOI: 10.1111/jocs.16589] [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: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/28/2022]
Abstract
There have been changes in the guidelines for surgical indications for aortopathy associated with bicuspid aortic valves over the last 10 years. Although the results of the last 3 years adhering to the latest guidelines have been shown to be good, careful follow-up and accumulation of new research findings are still required.
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Affiliation(s)
- Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Hamala P, Kasprzak JD, Lipiec P, Sobczak-Kaleta M, Wierzbowska-Drabik K. Higher rate of aortic stenosis progression in patients with bicuspid versus tricuspid aortic valve - A single center experience. Adv Med Sci 2021; 66:343-350. [PMID: 34280706 DOI: 10.1016/j.advms.2021.07.004] [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: 10/13/2020] [Revised: 05/28/2021] [Accepted: 07/11/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE We sought to investigate aortic stenosis (AS) progression rate (pr) with the comparison between bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) morphology. MATERIALS AND METHODS We compared ASpr in patients with BAV and TAV examined by transthoracic echocardiography (TTE) in the years 2004-2019. RESULTS Data from 363 TTEs in 161 AS patients (median age 70 [61-77] years; 63% men; 25% with BAV; 20% with severe AS) performed at different time points (median time interval 10 months) was analyzed. We assessed changes of AS severity with peak velocity through aortic valve (Vmax), mean/peak pressure gradients (MG/PG), aortic valve area by planimetry and continuity equation (AVAce). We compared pr (defined as parameter change per year) between the BAV and the TAV groups. BAV patients showed faster ASpr with odds ratio 3.467 and 95% confidence intervals 1.36 to 8.86, moreover, expressed as a quicker AVAce decrease 0 (-0.4-0.0) in the BAV vs. 0 (-0.15 - 0.0) cm2/year in the TAV group, p = 0.02. Furthermore, in BAV, female sex was associated with lower ASpr (p = 0.01), and in the whole group a larger aortic diameter was a predictor of faster progression (p < 0.001). CONCLUSION The ASpr, expressed as a decrease in the AVAce, was faster in BAV. Moreover, ASpr depends on both: valve morphology being faster in BAV and Vmax increase. Furthermore, the female sex was related to slower pace of AVA reduction in BAV subgroup whereas the larger baseline aortic diameter associated to faster AS progression in the whole studied group.
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Chen H, Liang H, Wang T, Zhao H, Yang J, Chen X. Evaluation of left ventricular myocardial mechanics in patients with normally functioning bicuspid aortic valves: A systematic review and meta-analysis. Echocardiography 2021; 38:834-843. [PMID: 33929759 DOI: 10.1111/echo.15042] [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: 12/23/2020] [Accepted: 03/11/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Studies have found conflicting results concerning the left ventricular (LV) myocardial deformation properties in patients with normally functioning bicuspid aortic valves (BAVs). Whether the remodeling process of LV occurs independently in patients with BAV is a matter of debate. METHOD We searched PubMed, Embase, Cochrane library, and Web of Science for cohort studies aiming to assess LV function in adults with isolated BAV compared with tricuspid aortic valve (TAV) controls. Standard mean difference (SMD) was calculated from random-effects meta-analyses. RESULTS Eight cohort studies were included. There were significantly lower global longitudinal strain (GLS), global radial strain (GRS), global circumferential strain (GCS) in BAV than in TAV controls (GLS: SMD = 0.64, 95% CI: 0.35 to 0.92, P < .0001; GRS: SMD = -0.71, 95% CI: -1.09 to -0.32, P = .0003; GCS: SMD = 0.70, 95% CI: 0.41 to 0.98, P < .00001) and significantly higher left atrial volume index (LAVI) and E/e' in BAV than in TAV controls (LAVI: SMD = 0.50, 95% Cl: 0.12 to 0.88, P = .01; E/e': SMD = 0.54, 95% CI: 0.30 to 0.77, P < .00001). There was significantly higher Left ventricular mass index(LVMI) in BAV than in TAV controls (SMD = 0.51, 95% CI: 0.24 to 0.79, P = .0003). Left ventricular ejection fraction (LVEF) was not significantly different between BAV patients and TAV controls (SMD = 0.05, 95% CI: -0.16 to 0.26, P = .63). CONCLUSION The impairment of LV myocardial mechanics, including LV systolic, diastolic dysfunction and LV hypertrophy, is present in patients with normally functioning BAV. This might support the hypothesis that BAV is not only a valvular disease but also a myocardial disease.
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Affiliation(s)
- Huiyun Chen
- Department of Cardiovascular Ultrasound, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Huili Liang
- Department of Cardiovascular Ultrasound, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Tao Wang
- Department of Cardiovascular Ultrasound, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Hongze Zhao
- Department of Cardiovascular Ultrasound, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Jun Yang
- Department of Cardiovascular Ultrasound, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Xin Chen
- Department of Cardiovascular Ultrasound, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
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Trysvetava YL. Bicuspid Aortic Valve: Morphology, Clinic, Diagnosis, Complications. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2021. [DOI: 10.20996/1819-6446-2021-02-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Bicuspid aortic valve refers to common (0.5-2% of the population) congenital heart defects that are asymptomatic throughout life, with valve dysfunction and/or aortopathy (pathia- from Greek pathos disease), manifested by expansion, aneurysm or dissection of the vessel. The pathogenesis of the formation of a bicuspid valve is unknown, a genetic component is noted, since the defect develops as sporadic, familial, in combination with other congenital heart defects and with hereditary connective tissue disorders. Morphogenetic studies suggest that different phenotypes of bicuspid aortic valve can be considered as etiologically different diseases, with valve dysfunction or valve dysfunction and aortopathy. Aortic lesion is characterized by phenotypic heterogeneity due to genetic or hemodynamic features. Researchers are discussing the relationship between the phenotype of the bicuspid aortic valve and aortopathy to predict the course of the disease and select the optimal surgical treatment technique. Diagnosis of heart disease is based on the results of an echocardiographic study, magnetic resonance imaging. Surgical treatment is performed for significant hemodynamic disturbances resulting from insufficiency or stenosis of the aortic valve, in cases of infective endocarditis, the risk of which is high, with aneurysm or aortic dissection.
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Park K, Park TH, Jo YS, Cho YR, Park JS, Kim MH, Kim YD. Prognostic effect of increased left ventricular wall thickness in severe aortic stenosis. Cardiovasc Ultrasound 2021; 19:5. [PMID: 33407517 PMCID: PMC7788729 DOI: 10.1186/s12947-020-00234-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 12/16/2020] [Indexed: 01/19/2023] Open
Abstract
Background It is unclear whether increased left ventricular (LV) thickness is associated with worse clinical outcomes in severe aortic stenosis (AS). The aim of this study was to determine the effect of increased LV wall thickness (LVWT) on major clinical outcomes in patients with severe AS. Methods and results This study included 290 severe AS patients (mean age 69.4 ± 11.0 years; 136 females) between January 2008 and December 2018. For outcome assessment, the endpoint was defined as death from all causes, cardiovascular death, and the aortic valve replacement (AVR) surgery rate. During follow-up (48.7 ± 39.0 months), 157 patients had AVR, 43 patients died, and 28 patients died from cardiovascular causes. Patients with increased LVWT underwent AVR surgery much more than those without LVWT (60.0% vs. 39.0%, p < 0.001). Furthermore, in patients with increased LVWT, the all-cause and cardiovascular death rates were significantly lower in the AVR group than in the non-AVR group (8.8% vs. 27.3%, p < 0.001, 4.8%, vs. 21.0%, p < 0.001). Multivariate analysis revealed that increased LVWT, age, dyspnea, and AVR surgery were significantly correlated with cardiovascular death. Conclusions In patients with severe AS, increased LVWT was associated with a higher AVR surgery rate and an increased rate of cardiovascular death independent of other well-known prognostic variates. Thus, these findings suggest that increased LVWT might be used as a potential prognostic factor in severe AS patients.
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Affiliation(s)
- Kyungil Park
- Division of Cardiology, Department of Internal Medicine, Dong-A University Hospital, Daeshingongwon-Ro 26, Seo-gu, Busan, 602-715, Republic of Korea
| | - Tae-Ho Park
- Division of Cardiology, Department of Internal Medicine, Dong-A University Hospital, Daeshingongwon-Ro 26, Seo-gu, Busan, 602-715, Republic of Korea.
| | - Yoon-Seong Jo
- Division of Cardiology, Department of Internal Medicine, Dong-A University Hospital, Daeshingongwon-Ro 26, Seo-gu, Busan, 602-715, Republic of Korea
| | - Young-Rak Cho
- Division of Cardiology, Department of Internal Medicine, Dong-A University Hospital, Daeshingongwon-Ro 26, Seo-gu, Busan, 602-715, Republic of Korea
| | - Jong-Sung Park
- Division of Cardiology, Department of Internal Medicine, Dong-A University Hospital, Daeshingongwon-Ro 26, Seo-gu, Busan, 602-715, Republic of Korea
| | - Moo-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Dong-A University Hospital, Daeshingongwon-Ro 26, Seo-gu, Busan, 602-715, Republic of Korea
| | - Young-Dae Kim
- Division of Cardiology, Department of Internal Medicine, Dong-A University Hospital, Daeshingongwon-Ro 26, Seo-gu, Busan, 602-715, Republic of Korea
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Debiec R, Hamby SE, Jones PD, Coolman S, Asiani M, Kharodia S, Skinner GJ, Samani NJ, Webb TR, Bolger A. Novel loss of function mutation in NOTCH1 in a family with bicuspid aortic valve, ventricular septal defect, thoracic aortic aneurysm, and aortic valve stenosis. Mol Genet Genomic Med 2020; 8:e1437. [PMID: 32720365 PMCID: PMC7549557 DOI: 10.1002/mgg3.1437] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 07/01/2020] [Accepted: 07/09/2020] [Indexed: 12/18/2022] Open
Abstract
Background Bicuspid aortic valve is the most common congenital valvular heart defect in the general population. BAV is associated with significant morbidity due to valve failure, formation of thoracic aortic aneurysm, and increased risk of infective endocarditis and aortic dissection. Loss of function mutations in NOTCH1 (OMIM 190198) has previously been associated with congenital heart disease involving the aortic valve, left ventricle outflow tract, and mitral valve that segregates in affected pedigrees as an autosomal dominant trait with variable expressivity. Methods We performed whole‐exome sequencing in four members of a three‐generational family (three affected and one unaffected subject) with clinical phenotypes including aortic valve stenosis, thoracic aortic aneurysm, and ventricular septal defect. Results We identified 16 potentially damaging genetic variants (one stop variant, one splice variant, and 14 missense variants) cosegregating with the phenotype. Of these variants, the nonsense mutation (p.Tyr291*) in NOTCH1 was the most deleterious variant identified and the most likely variant causing the disease. Conclusion Inactivating NOTCH1 mutations are a rare cause of familial heart disease involving predominantly left ventricular outflow tract lesions and characterized by the heterogeneity of clinical phenotype.
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Affiliation(s)
- Radoslaw Debiec
- Department of Cardiovascular Sciences, University of Leicester, NIHR (National Institute for Health Research) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Stephen E Hamby
- Department of Cardiovascular Sciences, University of Leicester, NIHR (National Institute for Health Research) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Peter D Jones
- Department of Cardiovascular Sciences, University of Leicester, NIHR (National Institute for Health Research) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Sue Coolman
- Department of Cardiovascular Sciences, University of Leicester, NIHR (National Institute for Health Research) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Manish Asiani
- Department of Cardiovascular Sciences, University of Leicester, NIHR (National Institute for Health Research) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Shireen Kharodia
- Department of Cardiovascular Sciences, University of Leicester, NIHR (National Institute for Health Research) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Gregory J Skinner
- East Midlands Congenital Heart Centre, Glenfield Hospital, Leicester, UK
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, University of Leicester, NIHR (National Institute for Health Research) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Tom R Webb
- Department of Cardiovascular Sciences, University of Leicester, NIHR (National Institute for Health Research) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Aidan Bolger
- Department of Cardiovascular Sciences, University of Leicester, NIHR (National Institute for Health Research) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK.,East Midlands Congenital Heart Centre, Glenfield Hospital, Leicester, UK
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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.
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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
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Pasipoularides A. Clinical-pathological correlations of BAV and the attendant thoracic aortopathies. Part 1: Pluridisciplinary perspective on their hemodynamics and morphomechanics. J Mol Cell Cardiol 2019; 133:223-232. [PMID: 31150733 DOI: 10.1016/j.yjmcc.2019.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/10/2019] [Accepted: 05/23/2019] [Indexed: 12/12/2022]
Abstract
Clinical BAV manifestations pertain to faulty aortic valve (AOV) function, the associated aortopathy, and other complications such as endocarditis, thrombosis and thromboembolism. BAV arises during valvulogenesis when 2 of the 3 leaflets/cusps of the AOV are fused together. Ensuing asymmetric BAV morphologies alter downstream ejection jet flow-trajectories. Based on BAV morphologies, ejection-flows exhibit different wall-impingement and scouring patterns in the proximal aorta, with excessive hydrodynamic wall-shear that correlates closely with mural vascular smooth muscle cell and extracellular matrix disruptions, revealing hemodynamic participation in the pathogenesis of BAV-associated aortopathies. Since the embryologic regions implicated in both BAV and aortopathies derive from neural crest cells and second heart field cells, there may exist a common multifactorial/polygenic embryological basis linking the abnormalities. The use of Electronic Health Records - encompassing integrated NGS variant panels and phenotypic data - in clinical studies could speed-up comprehensive understanding of multifactorial genetic-phenotypic and environmental factor interactions. This Survey represents the first in a 2-article pluridisciplinary work. Taken in toto, the series covers hemodynamic/morphomechanical and environmental (milieu intérieur) aspects in Part 1, and molecular, genetic and associated epigenetic aspects in Part 2. Together, Parts 1-2 should serve as a reference-milestone and driver for further pluridisciplinary research and its urgent translations in the clinical setting.
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Affiliation(s)
- Ares Pasipoularides
- Duke/NSF Center for Emerging Cardiovascular Technologies, Emeritus Faculty of Surgery and of Biomedical Engineering, Duke University School of Medicine and Graduate School, Durham, NC, USA.
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Evangelista A, Galian-Gay L. Aorta flow characteristics may provide key information to understand the aorta dilation in bicuspid aortic valve. Heart 2019; 104:1891-1892. [PMID: 30366933 DOI: 10.1136/heartjnl-2018-313791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
| | - Laura Galian-Gay
- Department of Cardiology, Vall d'Hebron Hospital, Barcelona, Spain
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