Failure to Prevent Progressive Dilation of Ascending Aorta by Aortic Valve Replacement in Patients With Bicuspid Aortic Valve: Comparison With Tricuspid Aortic Valve

Abstract

Background-Patients with bicuspid aortic valve (BAV) have been frequently complicated with ascending aortic dilation possibly because of hemodynamic burdens by aortic stenosis (AS) or regurgitation (AR) or congenital fragility of the aortic wall. Methods and Results-To clarify if the aortic dilation could be prevented by aortic valve replacement (AVR) in BAV patients, we studied 13 BAV (8 AR dominant, 5 AS dominant) and 14 tricuspid aortic valve (TAV) patients (7 AR, 7 AS) by echocardiography before and after AVR (9.7Ϯ4.8 years). We also studied 18 BAV (11 AR, 7 AS) without AVR. Diameters of the sinuses of Valsalva, sinotubular junction and the proximal aorta were measured. The annual dilation rate was calculated by dividing changes of diameters during the follow-up period by the body surface area and the observation interval. We found that aortic dilation in BAV patients tended to be faster than that in TAV patients, although a significant difference was found only at the proximal aorta (0.18Ϯ0.08 versus Ϫ0.08Ϯ0.08 mm/(m 2 /year), Pϭ0.03). BAV patients with and without AVR showed similar progressive dilation. AR dominant group showed tendency of more progressive dilation than AS dominant group in BAV, although it did not reach statistical significance. TAV patients did not show further aortic dilation after AVR. Conclusions-AVR could not prevent progressive aortic dilation in BAV. Since the aorta did not dilate in TAV, progressive aortic dilation in BAV seems mainly due to the fragility of the aortic wall rather than hemodynamic factors.

Histone Deacetylase 3 Coordinates Deacetylase-independent Epigenetic Silencing of Transforming Growth Factor-β1 (TGF-β1) to Orchestrate Second Heart Field Development

“…Patients with bicuspid aortic valve, the most common congenital heart defect, are at increased risk for ascending aortic dilatation (73). Proteoglycans facilitate collagen assembly and synthesis, a critical process for the development of semilunar valves and ascending aorta (37).…”

Surgical treatment of ascending aortic false aneurysm

“…Потенциальные участки формирования ЛА: область наложения поперечного за-жима, линия шва и места катетеризации аорты, границы анастомозов [4,7]. Пациенты с двустворчатым АК нахо-дятся в группе повышенного риска развития осложнений со стороны аорты, при этом замена АК полностью не ис-ключает возможность прогрессирования дилатации [8,9]. Клиническая картина при этой патологии размыта и может варьировать от бессимптомного течения до лихо-радочных состояний, учитывая частую ассоциацию с ИЭ [1].…”

Surgical Treatment of Bicuspid Aortic Valve Disease

“…Studies on children (Beroukhim et al, 2006;Warren et al, 2006;Holmes et al, 2007) and adults (Yasuda et al, 2003;Davies et al, 2007;Tadros et al, 2009) have reported significantly faster aortic dilatation in the significantly younger with BAV versus trileaflet aortic valve (Figure). BAV is associated with ascending aortic dilatation and enlargement of the aortic root annulus in as many as half of all individuals (Nkomo et al, 2003;Park et al, 2011).…”