Bicuspid aortic valve leaflet morphology in relation to aortic root morphology: a study of 300 patients undergoing open-heart surgery.
ABSTRACT There is an ongoing discussion regarding the mechanism of aortic dilatation in bicuspid aortic valve (BAV) disease, that is, is this a hemodynamic effect or related to an inborn weakness of the aortic wall? This study evaluated the possibility of BAV morphology being related to ascending aorta morphology as such a correlation would strengthen the idea that hemodynamic alterations cause the dilatation of the aorta.
The morphology of the ascending aorta of 300 patients admitted for aortic valve and/or ascending aorta disease was evaluated by echocardiography and related to the surgeon's inspection of the aortic valve.
A tricuspid aortic valve (TAV), BAV, or unicuspid aortic valve (UAV) was present in 130, 160, and 10 patients, respectively. Ascending aortic aneurysm was more common in patients with BAV compared with TAV (36% and 12%, respectively; p < 0.001), while ectasia of the aorta was similarly common (8% in both groups). Aortic stenosis or regurgitation was equally distributed in TAV and BAV patients with normal aortas (p=0.82). When the aorta was dilated, aortic stenosis was predominantly associated with BAV (BAV 56%, TAV 4%; p < 0.001), while aortic regurgitation was more common in TAV (TAV 81%, BAV 29%; p<0.001). In BAV patients, fusion of the right- and left coronary cusp was predominant (74%) followed by right- and non-coronary cusp fusion (14%) and true BAV (fusion of the right- and left coronary cusp without remnant raphe; 11%) (p < 0.001). The relative distribution of ascending aortic aneurysm or ectasia was similar in all morphologically different BAV (p = 0.95).
In our study population, >50% of the patients admitted for surgery had a bicuspid valve. Aortic aneurysm was more common in BAV than in TAV patients. Aortic stenosis and aortic regurgitation were equally common in TAV and BAV with normal aortic dimensions, while aortic regurgitation was predominant in TAV with dilated aortas and aortic stenosis in BAV with dilated aortas. Dilatation of the aorta was similarly distributed regardless of BAV leaflet morphology. These findings support the idea of an intrinsic mechanisms underlying dilatation of the aorta in BAV patients.
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ABSTRACT: Cardiac imaging continues to reveal new anatomical and functional insights into heart disease. In echocardiography, both transesophageal and transthoracic three-dimensional imaging have been fully developed and optimized, and the value of the techniques that have increased our understanding of cardiac mechanics and ventricular function is well established. At the same time, the healthcare industry has released new devices onto the market which, although they are easier to use, have limitations that restrict their use for routine assessment. Tomography's diagnostic and prognostic value in coronary artery disease continues to increase while radiation exposure becomes progressively lower. With cardiac magnetic resonance imaging, myocardial injury and recovery in ischemic heart disease and following acute coronary syndrome can be monitored in exquisite detail. The emergence of new combined tomographic and gamma camera techniques, exclusively developed for nuclear cardiology, have improved the quality of investigations and reduced radiation exposure. The hybrid or fusion images produced by combining different techniques, such as nuclear cardiology techniques and tomography, promise an exciting future.Revista Espa de Cardiologia 01/2012; 65 Suppl 1:24-34. · 2.53 Impact Factor
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ABSTRACT: The bicuspid aortic valve is a common congenital heart disease characterised by inequality of cusp size, a central raphe, and smooth cusp margins even in diseased valves. It may progress and become calcified, leading to varying degrees of aortic valve disorders, such as stenosis, regurgitation, or combined, which may eventually necessitate surgical intervention. The bicuspid aortic valve is not a disorder confined to the aortic valve, but a spectrum involving the aortic valve, aortic annulus, aortic root, ascending aorta, and the left ventricular outflow tract. Different types of bicuspid aortic valves may present with distinct aetiologies and morphologies. The anatomopathological features of the bicuspid aortic valve have not been sufficiently elucidated. Differences in the anatomy of the bicuspid aortic valve could reflect different pathogeneses and different needs for different therapeutic approaches. Debates still remain in terms of timing of surgery and surgical indications of this disorder. The aim of the present article is to make a review of the anatomy and the management strategies of the bicuspid aortic valve in order to draw inferences about the clinical implications.Folia morphologica 11/2011; 70(4):217-27. · 0.52 Impact Factor