Aortic dimensions in patients with bicuspid aortic valve without significant valve dysfunction

Cecconi, Moreno; Manfrin, Marcello; Moraca, Alessandra; Zanoli, Raffaele; Colonna, Pier Luigi; Bettuzzi, Maria Grazia; Moretti, Stefano; Gabrielli, Domenico; Perna, Gian Piero

doi:10.1016/j.amjcard.2004.08.098

Cited by 119 publications

(91 citation statements)

References 16 publications

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“…However, both BAV subtypes had larger ascending aorta diameter than controls, and its pathologic dilatation at the level of ascending aorta was more often in both BAV subtypes, but type I BAV predisposed to greater dimensions at level of the sinuses of Valsalva and the ascending aorta in comparison to type II BAV. Although it has been proven that patients with type I BAV carry a higher risk of aortic dilatation [16,22], Cecconi et al [23] observed no significant difference between BAV subtypes in aortic dimensions. Additionally Khoo et al [4] showed significantly larger indexed diameters only at the level of the sinuses of Valsalva in patients with type I BAV.…”

Section: Discussionmentioning

confidence: 99%

Bicuspid aortic valve morphology and its association with aortic diameter: an echocardiographic study

2016

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A b s t r a c tBackground: Bicuspid aortic valve (BAV) is strongly associated with aortopathy. Previous studies have suggested that various types of bicuspid aortic valve morphology may differently affect the aortic dilatation. Aim:To evaluate the impact of BAV cusp fusion morphology (type I -right-left coronary cusp fusion; type II -right-noncoronary cusp fusion) on the diameters of the aorta.Methods: BAV morphology was evaluated retrospectively in a group of 67 consecutive patients with BAV. The control group comprised 1000 randomly selected patients with normal tricuspid aortic valve. Aortic dimensions and other echocardiographic parameters were obtained from the echocardiography database of our department. The diameters of aorta in both BAV subtypes were evaluated at the level of: annulus, the sinus of Valsalva, the sinotubular junction, and the ascending aorta and at the level of the ascending aorta in the control group.Results: Patients with BAV were mainly male (78%), with a mean age of 55.3 ± 16.7 years. The dominant morphology of BAV in the study group was type I (n = 46; 69%). It was associated with increased aortic dimension in comparison to type II BAVs at the level of the sinuses of Valsalva (38.4 ± 5.2 vs. 34.0 ± 4.6 mm, p = 0.002), the sinotubular junction (33.1 ± 5.8 vs. 29.6 ± 5.0 mm, p = 0.035), and the ascending aorta (41.6 ± 7.1 vs. 36.6 ± 6.1 mm, p = 0.006). Indexed aortic diameter was also increased in type I BAV at the level of sinuses of Valsalva (19.6 ± 2.7 vs. 18.1 ± 1.6 mm/m 2 , p = 0.008) and the ascending aorta (21.3 ± 3.4 vs. 19.3 ± 3.4 mm/m 2 , p = 0.048). The dimensions of the ascending aorta exceeding the upper normal range limit based on control-group measurements (44.3 mm) were observed more frequently in type I than in type II (33% vs. 10%, p = 0.044). Aortic regurgitation (moderate or severe) occurred in similar percentages of both BAV subtypes (type I: 37% vs. type II: 33%, p = 0.774). There were also no significant differences in aortic valve area (2.2 ± 1.1 vs. 2.0 ± 1.4 cm 2 , p = 0.163), indexed aortic valve area (1.1 ± 0.6 vs. 1.0 ± 0.6, p = 0.337), peak transvalvular gradient (35.3 ± 20.5 vs. 39.1 ± 28.9 mm Hg, p = 0.862), and mean gradient (18.6 ± 12.3 vs. 22.7 ± 18.2 mm Hg, p = 0.571) and left ventricular ejection fraction (51.8 ± 11.6 vs. 51.8 ± 12.2%, p = 0.978) between type I and type II BAV groups.Conclusions: Type I BAV cusp fusion morphology is more commonly associated with dilatation of the aorta than type II, especially at the level of the sinus of Valsalva and the ascending aorta.

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Section: Discussionmentioning

confidence: 99%

Bicuspid aortic valve morphology and its association with aortic diameter: an echocardiographic study

2016

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“…After the GOA of the BAV started increasing, the mean velocity decreases to 1 m/s and then again starts rising but at smaller rate than during the initial phase t < t 1 . The value of the mean velocity reaches its maximum 2.6 m/s, which is considered rather high from the clinical standpoint as it further indicates the occurrence of mild/moderate aortic stenosis [41][42][43]. The mean velocity of the TAV, on the other hand, accelerates more gradually, and the maximum value does not exceed 1.7 m/s.…”

Section: Comparison Of Tav and Bav Kinematicsmentioning

confidence: 92%

Comparative hemodynamics in an aorta with bicuspid and trileaflet valves

Gilmanov

Sotiropoulos

2015

Theor. Comput. Fluid Dyn.

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Bicuspid aortic valve (BAV) is a congenital heart defect that has been associated with serious aortopathies, such as aortic stenosis, aortic regurgitation, infective endocarditis, aortic dissection, calcific aortic valve and dilatation of ascending aorta. There are two main hypotheses to explain the increase prevalence of aortopathies in patients with BAV: the genetic and the hemodynamic. In this study, we seek to investigate the possible role of hemodynamic factors as causes of BAV-associated aortopathy. We employ the curvilinear immersed boundary method coupled with an efficient thin-shell finite-element formulation for tissues to carry out fluid-structure interaction simulations of a healthy trileaflet aortic valve (TAV) and a BAV placed in the same anatomic aorta. The computed results reveal major differences between the TAV and BAV flow patterns. These include: the dynamics of the aortic valve vortex ring formation and break up; the large-scale flow patterns in the ascending aorta; the shear stress magnitude, directions, and dynamics on the heart valve surfaces. The computed results are in qualitative agreement with in vivo magnetic resonance imaging data and suggest that the linkages between BAV aortopathy and hemodynamics deserve further investigation.Keywords Bicuspid valve · Trileaflet valve · Fluid-structure interaction · Immersed boundary method · Finite element · Thin shell · Rotation-free approach

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“…Furthermore, among patients with BAV or TAV presenting for aortic valve replacement and matched for their degree of aortic stenosis, those with BAV were found more commonly to have more severe dilatation of the aorta [Morgan-Hughes et al, 2004]. Among children, likewise, Cecconi et al [2005] found a significant association between BAV and increased aortic arch dimension but no correlation with valve dysfunction among 162 consecutive subjects with isolated BAV. This same study found no association between morphology of the BAV and the frequency of aortic dilation.…”

Section: Introductionmentioning

confidence: 91%

Familial thoracic aortic dilation and bicommissural aortic valve: A prospective analysis of natural history and inheritance

Loscalzo

Goh

Loeys

et al. 2007

American J of Med Genetics Pt A

193

133

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The autosomal dominant inheritance of bicommissural aortic valve (BAV) (Online Mendelian Inheritance in Man #109730) in some families is well-documented; however, the inheritance of BAV with thoracic aortic aneurysm (TAA) is less clear. Whether the aneurysm is secondary to hemodynamic perturbation related to the valve abnormality or a primary manifestation of the disorder remains controversial. Guidelines are needed regarding the follow-up and treatment of these patients and their families. Thirteen families with at least one individual with TAA and BAV (BAV/TAA) were evaluated prospectively by standard echocardiographic methods or clinical history. Affected status was determined by the presence of BAV or TAA or a history of dissection, rupture, or surgical repair. Six of 13 families had at least two family members with both BAV and TAA, often in successive generations. Informatively, all 13 families had at least one family member with TAA in the absence of BAV. Thirty-five percent (39/110) of family members had BAV/TAA or TAA, and the majority of families (11/13) had maximal dilatation above the sinotubular junction (STJ). Vascular dissection or rupture occurred in seven of 13 families and in individuals with structurally normal aortic valves. Two families had non-manifesting, obligate carriers. Three families have members with other left heart outflow tract anomalies. This study confirms autosomal dominant inheritance with incomplete penetrance for BAV/TAA in these families. Furthermore, our data suggest that the component features, BAV and TAA, are independent manifestations of a single gene defect. To avoid the risk of early death, it is essential that all first-degree relatives receive echocardiographic follow-up at regular intervals regardless of the presence or absence of a BAV. This assessment must include imaging of the aortic region above the STJ.

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Aortic dimensions in patients with bicuspid aortic valve without significant valve dysfunction

Cited by 119 publications

References 16 publications

Bicuspid aortic valve morphology and its association with aortic diameter: an echocardiographic study

Bicuspid aortic valve morphology and its association with aortic diameter: an echocardiographic study

Comparative hemodynamics in an aorta with bicuspid and trileaflet valves

Familial thoracic aortic dilation and bicommissural aortic valve: A prospective analysis of natural history and inheritance

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