Features and predictors of ascending aortic dilatation in association with a congenital bicuspid aortic valve

Novaro, Gian M.; Tiong, Irving; Pearce, Gregory L.; Grimm, Richard A.; Smedira, Nicholas G.; Griffin, Brian P.

doi:10.1016/s0002-9149(03)00480-6

Cited by 102 publications

(63 citation statements)

References 5 publications

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“…10,30,32 Increased stroke volume in AR increases aortic wall shear stress, which may drive progressive dilatation in the setting of intrinsic connective-tissue abnormalities in the BAV aorta. 10,13,33 By contrast, we found an association between severe AR and decreased AD.…”

Section: Resultsmentioning

confidence: 99%

Statin Use and Aneurysm Risk in Patients With Bicuspid Aortic Valve Disease

Taylor

Yadlapati

Andrei

et al. 2015

Clinical Cardiology

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Background: No medical therapy has been proven to prevent the progression of aortic dilatation in bicuspid aortic valve (BAV) disease, and prophylactic aortic surgery remains the mainstay of treatment. Hypothesis: Among patients with BAV disease who are referred for surgery, preoperative statin use is associated with decreased odds of ascending aortic dilatation. Methods: We reviewed all BAV patients who underwent aortic valve and/or aortic surgery at our center between April 2004 and December 2013. Aortic diameter (AD), defined as the maximum ascending aortic dimension, was determined by magnetic resonance imaging, computed tomography, or echocardiography. Patients were divided into 2 groups: maximal AD <4.5 cm or ≥4.5 cm. The association between preoperative statin use and aortic dilatation was assessed using multivariable logistic regression modeling. Results: Of 680 consecutive patients, 405 (60%) had AD <4.5 cm (mean age, 60 ± 14 years; 45% on statins), whereas 275 (40%) had AD ≥4.5 cm (mean age, 54 ± 13 years; 35% on statins) at the time of surgery. After adjusting for age, body surface area, sex, hypertension, aortic stenosis, severity of aortic regurgitation, and use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and β-blockers, patients with AD ≥4.5 cm had 0.66× lower odds (95% confidence interval: 0.45-0.96) of being on preoperative statins compared with those with AD <4.5 cm (P = 0.029). Conclusions: In a retrospective study of BAV patients referred for surgery, preoperative statin use was associated with lower odds of clinically significant ascending aortic dilatation.

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Section: Resultsmentioning

confidence: 99%

Statin Use and Aneurysm Risk in Patients With Bicuspid Aortic Valve Disease

Taylor

Yadlapati

Andrei

et al. 2015

Clinical Cardiology

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“…Rabkinв метанализе проведенных ранее исследований также резюмировал, что в группе пациентов с аневризмой грудной аорты в сочетании с ДАК имеется повышенное содержание МПТ-2 и сниженное ТИМП-1 в сравнении с другими группами [56]. Исследование материала у пациентов с синдромом Марфана выявило повышенное содержание МПТ-12 (эластаза), ТИМП-2 и в свою очередь сниженное содержание МПТ-1, ТИМП-3 [57]. Сравнительный анализ исследований в отношении анализа содержания МПТ и ТИМП показал противоречивые результаты, вероятно вследствие малой выборки и различных зон аорты, из которых были проведены исследования.…”

Section: повышенная активность металлопротеи-назunclassified

“…ДАК с недостаточностью имеют больший ударный объем, приводящий к повышению давления растяжения стенки восходящего отдела аорты. Тяжесть степени недостаточности АК коррелирует со степенью дилятации корня аорты [60,61]. Здесь может наблюдаться бимодальный эффект, который заключается в том, что увеличение корня аорты ведет к плохой коаптации створок аорты, что в свою очередь приводит к увеличению недостаточности.…”

Section: гемодинамический факторunclassified

“…ДАК со стенозом вызывает образование высокоскоростного потока, который оказывает высокое давление на антелатеральную зону восходящего отдела аорты [62]. Доказательства зависимости степени дилятации корня аорты от степени стеноза АК в настоящее время противоречивы [61,63,64].…”

Section: гемодинамический факторunclassified

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Aortopathy pathophysiology features in patients with bicuspid aortic valve.

et al. 2016

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This review is devoted to one of the vital topics in cardiovascular surgery -pathophysiologyof an aortopathy in case of bicuspid aortic valve. In the article reviewed the modern point of view on a problem considering new achievements in genetics, molecular biology and altered haemodynamic.Key words: aortic aneurysm-bicuspid aortic valve-metalloproteinase. ТұжырымдамаӘдебиетке болжамдалған шолу қантамырлық-жүрек хирургиясының өзекті тақырыптарының бірі -екі жақтаулы аорталық қақпашасы бар пациенттерде патофизиологиялық аортопатияның ерекшеліктеріне арналған. Мақалада генетикадағы, молекулярлық биологиядағы, гемодинамика патологиясындағы жаңа жетістіктер ескеріле отырып, проблемаға заманауи тұрғыдағы көзқарас берілен.Маңызды сөздер: аорта аневризмі -екі жақтаулы аорталық қақпаша -металлопротеиназдар.оСоБенноСти патофизиологии аортопатии у пациентов С двуСтворчатыМ аортальныМ клапаноМ. Сейдалин а.о. 1 ,туганбеков т.у. 2 , диколаев в.д. 2,3, айталиев С.е 3 .1 «Городской кардиологический центр», отделение кардиохирургии, Алматы, Казахстан 2 «Медицинский Университет Астана», кафедра хирургии, Астана, Казахстан 3«Национальный научный медицинский центр», отделение кардиохирургии, Астана, Казахстан Резюме.Предполагаемый обзор литературы посвящен одной из актуальных тем в сердечно-сосудистой хирургии -патофизиологии аортопатии при двустворчатом аортальном клапане. В статье дан современный взгляд на проблему с учетом новых достижений в генетике, молекулярной биологии, патологии гемодинамики.Ключевые слова: аневризма аорты -двустворчатый аортальный клапан -металлопротеиназы.

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“…16 Dilatation of the thoracic aorta, most commonly located in the ascending aorta, has been reported in 35-80% of adult BAV patients and has rarely been observed as early as childhood. [11][12][13][14][20][21][22][23][24][25] In adults TAA is defined as an aortic diameter with a z-score of ≥2, corresponding to an observed value >1.96 standard deviations above the predicted value for age, gender, and body surface area (BSA). 26 An aortic root >4.0 cm in adults is considered to be dilated irrespective of age, gender or BSA.…”

Section: Bicuspid Aortic Valve: Clinical and Genetic Aspectsmentioning

confidence: 99%

Clinical and Genetic Aspects of Bicuspid Aortic Valve: A Proposed Model for Family Screening Based on a Review of Literature

et al. 2015

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Bicuspid aortic valve (BAV) is the most common congenital cardiac defect causing serious morbidity including valvular dysfunction and thoracic aortic aneurysms (TAA) in around 30% of BAV patients. Cardiological screening of first-degree relatives is advised in recent guidelines given the observed familial clustering of BAV. However, guidelines regarding screening of family members and DNA testing are not unequivocal. The aim of this review is to provide an overview of the literature on echocardiographic screening in first-degree relatives of BAV patients and to propose a model for family screening. In addition, we provide a flowchart for DNA testing. We performed a PubMed search and included studies providing data on echocardiographic screening in asymptomatic relatives of BAV patients. Nine studies were included. In 5.8-47.4% of the families BAV was shown to be familial. Of the screened first-degree relatives 1.8-11% was found to be affected with BAV. Results regarding a potential risk of TAA in first-degree relatives with a tricuspid aortic valve (TAV) were conflicting. The reported familial clustering of BAV underlines the importance of cardiological screening in relatives. After reviewing the available family history, patient characteristics and the results of cardiological screening in relatives, follow-up in relatives with a TAV and/or DNA testing may be advised in a subset of families. In this study we propose a model for the clinical and genetic work-up in BAV families, based on the most extensive literature review on family screening performed until now.

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Features and predictors of ascending aortic dilatation in association with a congenital bicuspid aortic valve

Cited by 102 publications

References 5 publications

Statin Use and Aneurysm Risk in Patients With Bicuspid Aortic Valve Disease

Statin Use and Aneurysm Risk in Patients With Bicuspid Aortic Valve Disease

Aortopathy pathophysiology features in patients with bicuspid aortic valve.

Clinical and Genetic Aspects of Bicuspid Aortic Valve: A Proposed Model for Family Screening Based on a Review of Literature

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