Morphometric analysis of aortic media in patients with bicuspid and tricuspid aortic valve

Comparison of the Structure of the Aortic Valve and Ascending Aorta in Adults Having Aortic Valve Replacement for Aortic Stenosis Versus for Pure Aortic Regurgitation and Resection of the Ascending Aorta for Aneurysm

“…Several investigators [25][26][27][28][29] have used multiple histological features (fibrosis, atherosclerosis, medionecrosis, cystic medial necrosis, loss or disorientation or apoptosis of smooth-muscle cells, elastic fiber fragmentation or disruption or distances between fibers, inflammation, pooling of mucoid material) to describe the media of ascending aorta in patients with normal or dysfunctioning bicuspid and tricuspid aortic valves. With one exception, 29 these investigators found more aortic wall alterations in the patients with bicuspid compared with those with tricuspid aortic valves.…”

ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease

“…In many patients with BAV, the histology of the aortic wall is similar to Marfan syndrome, with abnormalities of smooth muscle, extracellular matrix, elastin, and collagen. [321][322][323] In general, the severity of valvular AS in adults is graded mild, moderate, or severe on the basis of the valve area and jet velocity across the aortic valve as measured by Doppler echocardiography. Degrees of AS are defined in the 2006 ACC/AHA valvular heart disease guidelines as mild (a valve area greater than 1.5 cm 2 , mean gradient less than 25 mm Hg, or jet velocity less than 3.0 ms), moderate (valve area 1.0 to 1.5 cm 2 , mean gradient 25 to 40 mm Hg, or jet velocity 3.0 to 4.0 ms), or severe (valve area less than 1.0 cm 2 , mean gradient greater than 40 mm Hg, or jet velocity greater than 4.0 m per s).…”

Ascending Aortic Dilatation Associated With Bicuspid Aortic Valve

“…15 The total thickness of the aortic media is the same for BAV and TAV aortas, but the distance between the elastic lamellae is greater with BAV, and the lamellae themselves are thinner and more fragmented ( Figure 2). 8,14,36 More recent evidence regarding elastin loss and fragmentation is conflicting. 37 Several BAV studies show noninflammatory loss of VSMCs, as described by Erdheim, 8,13,38 with similar degrees of VSMC apoptosis in Marfan aortas 8 and preserved density of VSMCs in idiopathic ascending aortic aneurysms.…”