Dissection of the aorta associated with congenital malformation of the aortic valve

Roberts, Charles S.; Roberts, William C.

doi:10.1016/s0735-1097(10)80188-3

Cited by 245 publications

(138 citation statements)

References 12 publications

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“…It has been reported that patients with bicuspid aortic valve are at increased risk of aneurysms of the ascending aorta, aortic dissections, and rupture. 10 However, in the current study, 2 out of 5 aortic events occurred in tricuspid valve patients, and bicuspid valve disease failed to be a risk factor for aortic enlargement or the occurrence of aortic events. This may be due to the small number of patients.…”

Section: Discussioncontrasting

confidence: 64%

Natural History of a Dilated Ascending Aorta After Aortic Valve Replacement

Matsuyama

Usui

Akita

et al. 2005

Circ J

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Background Little information is available regarding the incidence of aortic dissection or rupture in patients with a dilated ascending aorta after aortic valve replacement (AVR). The present clinical study aimed to demonstrate the incidence of aortic complications after AVR in patients with a dilated ascending aorta and to clarify those risk factors associated with the progression of a dilated ascending aorta or late aortic events. Methods and Results A total of 35 patients with a dilated ascending aorta at the time of AVR were enrolled. A dilated ascending aorta was defined as 40 mm or greater in diameter by preoperative computed tomography or operative findings. The baseline ascending aorta diameter ranged from 40 to 55 mm with a mean of 44.8±4.4 mm. There was a high frequency of bicuspid valve disease in patients with a dilated ascending aorta (57%). The mean follow-up interval was 8.1±3.5 years (range: 2.3-13). Aortic events occurred in 5 patients (aortic dissection in 1, rupture in 2, reoperation in 2) during the follow-up. One aortic dissection developed at a baseline aortic size of 42 mm, whereas 2 aortic ruptures occurred at baseline aortic sizes of 47 mm and 50 mm. There was no statistically significant univariate association between any of the patient clinical characteristics and late aortic events or ascending aortic progression. Conclusion Although the clinical course of patients with a dilated ascending aorta is unpredictable, aortic events may occur even in patients with a baseline aortic diameter of <50 mm. Therefore, preventive aortic surgery at the time of AVR should be considered to prevent aortic dissection or rupture in patients with an even slightly dilated ascending aorta with a diameter of 40 to 50 mm, unless the patient has a high operative risk or older age. (Circ J 2005; 69: 392 -396)

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Section: Discussioncontrasting

confidence: 64%

Natural History of a Dilated Ascending Aorta After Aortic Valve Replacement

Matsuyama

Usui

Akita

et al. 2005

Circ J

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“…Patients with congenitally bicuspid aortic valves have a higher frequency of aortic dissection with tears in the ascending aorta than do patients with tricuspid aortic valves 34 : Ն9% of our patients (5/56) had congenitally bicuspid valves: loss of medial elastic fibers in them was 0 in 1, 1ϩ in 2, and 3ϩ in 2 patients. The bicuspid valves were heavier than the tricuspid valves (mean 1.14 vs 0.62 g).…”

Section: Discussionmentioning

confidence: 61%

Aortic Medial Elastic Fiber Loss in Acute Ascending Aortic Dissection

Roberts

Vowels

Kitchens

et al. 2011

The American Journal of Cardiology

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The cause of acute aortic dissection continues to be debated. One school of thought suggests that underlying aortic medial cystic necrosis is the common denominator. The purpose of the present study was to determine if there was loss and, if so, how much loss of medial elastic fibers in the ascending aorta in patients with acute aortic dissection with the entrance tear in the ascending aorta. We examined operatively excised ascending aortas in 69 patients having acute dissection with tears in the ascending aorta. Patients with previous aortotomy, healed dissection, and connective tissue disorders were excluded. The 69 patients' ages ranged from 31 to 88 years (mean 56); 49 were men and 20 were women. Loss of aortic medial elastic fibers was graded as 0 (no loss), 1؉ (trace), 2؉ (mild), 3؉ (moderate), and 4؉ (full thickness loss). Of these 69 patients, 56 (82%) had 0 or 1؉ elastic fiber loss; 13 patients (18%), 2؉ to 4؉ loss including 4 with 2؉, 6 with 3؉, and 2 with 4؉. Nearly all patients (97%) had a history of systemic hypertension and/or had received antihypertensive drug therapy. In conclusion, most patients (82% in this study) having acute aortic dissection with entrance tears in the ascending aorta have normal numbers or only trace loss of aortic medial elastic fibers. Thus, underlying abnormal ascending aortic structure uncommonly precedes acute dissection.

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“…[1][2][3] In recent years BAV has also been found to be a risk factor for proximal aortic dilatation and dissection. [4][5][6][7][8][9][10] Recently, a study in a large group of adults suggested that the presence of aortic insufficiency or stenosis may alter the risk of developing ascending aorta dilatation in an adult population with BAV. 11 Indeed, nearly all of the studies conducted to date have reported on adults.…”

mentioning

confidence: 99%

Dilatation of the ascending aorta in paediatric patients with bicuspid aortic valve: frequency, rate of progression and risk factors

Warren

Boyd²,

O’Connell³

et al. 2006

Heart

116

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Objectives: To describe the incidence and rate of dilatation of the ascending aorta in children with bicuspid aortic valve (BAV) and to determine factors that predict rapid aortic dilatation. Design: Retrospective cohort study. Setting: Regional tertiary care children's hospital. Patients: All children aged 0-18 years seen at the authors' institution between 1990 and 2003 with an ''isolated'' BAV. All patients had had more than one technically adequate echocardiogram, at least six months apart, with concomitant height and weight data. Interventions: Offline echocardiographic measurements of multiple levels of the aortic root were completed for each participant at each serial echocardiogram. These measurements were then compared with expected measurements derived from a normal local control population. Main outcome measures: Rate of change of the ascending aorta size over time, where aortic size is expressed as the number of standard deviations above or below the mean size expected for a given body surface area (z score). Results: 279 echocardiograms spanning a period of from 9 months to 13.3 years were analysed for 88 patients with BAV. The ascending aorta in the BAV group was larger than expected for body surface area at diagnosis and continued to increase in relative size at each of the four subsequent follow-up echocardiograms. Ascending aortic z score increased at an average rate of 0.4/year. A faster rate of increase in z score was predicted by both larger initial aortic valve gradient and non-use of b blockers. Conclusions: Children with BAV are at risk of having a dilated ascending aorta. This risk increases with longer follow up.

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Dissection of the aorta associated with congenital malformation of the aortic valve

Cited by 245 publications

References 12 publications

Natural History of a Dilated Ascending Aorta After Aortic Valve Replacement

Natural History of a Dilated Ascending Aorta After Aortic Valve Replacement

Aortic Medial Elastic Fiber Loss in Acute Ascending Aortic Dissection

Dilatation of the ascending aorta in paediatric patients with bicuspid aortic valve: frequency, rate of progression and risk factors

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