Comparative Histology of Aortic Dilatation Associated With Bileaflet Versus Trileaflet Aortic Valves

Heng, Elbert E.; Stone, James R.; Kim, Joon Bum; Lee, Hang; MacGillivray, Thomas E.; Sundt, Thoralf M.

doi:10.1016/j.athoracsur.2015.05.105

Cited by 31 publications

(23 citation statements)

References 30 publications

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“…6 It has been shown that a nondilated BAV ascending aorta has degraded elastic lamella fibers compared with nondilated TAV ascending aorta. 7 However, a study by Heng and colleagues 8 has suggested a more severe histologic abnormality in dilated TAV versus BAV aortas. Further extending these concepts, it has been suggested that the cause of aortic dilation is different in patients with aortic stenosis (AS) and aortic insufficiency (AI) and is based on TAV and BAV morphology, histology, and hemodynamic flow patterns.…”

Section: See Editorial Commentary Page 433mentioning

confidence: 99%

Fate of remnant sinuses of Valsalva in patients with bicuspid and trileaflet valves undergoing aortic valve, ascending aorta, and aortic arch replacement

Milewski

Habertheuer

Bavaria

et al. 2017

The Journal of Thoracic and Cardiovascular Surgery

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In patients with nonaneurysmal sinuses of Valsalva undergoing aortic valve replacement with supracoronary ascending aorta replacement, the sinus segment can be preserved irrespective of the type of valvular pathology (aortic stenosis vs aortic insufficiency) or valvular morphology (bicuspid aortic valve vs tricuspid aortic valve). Aortic valve replacement with supracoronary ascending aorta replacement may have a stabilizing effect on the sinus segment over long-term follow-up in patients with tricuspid aortic valves or bicuspid aortic valves.

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Section: See Editorial Commentary Page 433mentioning

confidence: 99%

Fate of remnant sinuses of Valsalva in patients with bicuspid and trileaflet valves undergoing aortic valve, ascending aorta, and aortic arch replacement

Milewski

Habertheuer

Bavaria

et al. 2017

The Journal of Thoracic and Cardiovascular Surgery

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“…The complexity is further confounded by the findings of Heng and colleagues. In this recent study, tissue pathology was compared between TAV and BAV patients at matched aortic diameters(76). At odds with conventional wisdom, more severe histologic abnormalities were found in trileaflet aortic valve aorta as compared with BAV, especially when stratified by diameter.…”

Section: Cellular and Molecular Mechanisms Of Bav Aortopathymentioning

confidence: 99%

Year in review

Fedak

Barker

Verma

2016

Current Opinion in Cardiology

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Purpose of Review To review and outline the key research contribution to BAV aortopathy over the past 18 months. Recent Findings Investigators have further defined the current gaps in knowledge and the scope of the clinical problem of BAV aortopathy. Support for aggressive resection strategies is waning as evidence mounts to suggest that BAV is not similar to genetic connective tissue disorders with respect to aortic risks. The role of cusp fusion patterns and valve-mediated hemodynamics on disease progression is a major area of discovery Molecular and cellular mechanisms remain elusive and contradictory. Summary BAV aortopathy is a major public health problem that remains poorly understood. New insights on valve-mediated hemodynamics using novel imaging modalities may lead to more individualized resection strategies and improved clinical guidelines.

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“…On the other hand, a strong genetic predisposition has been suggested to contribute to aortopathy in BAV patients. Interestingly, a recent study showed that TAV aortopathy was associated with more severe histologic abnormalities compared to BAV aortopathy, especially when stratified by diameter (Heng et al, 2015). Properly assessing the diagnostic value of novel imaging biomarkers requires further work in this area to gain a better appreciation of the differences in the development of BAV vs. TAV aortopathy.…”

Section: Imaging Hemodynamic Biomarkers and Aortic Wall Pathologymentioning

confidence: 99%

Evolution of Precision Medicine and Surgical Strategies for Bicuspid Aortic Valve-Associated Aortopathy

et al. 2017

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Bicuspid aortic valve (BAV) is a common congenital cardiac malformation affecting 1–2% of people. BAV results from fusion of two adjacent aortic valve cusps, and is associated with dilatation of the aorta, known as bicuspid valve associated aortopathy. Bicuspid valve aortopathy is progressive and associated with catastrophic clinical events, such as aortic dissection and rupture. Therefore, frequent monitoring and early intervention with prophylactic surgical resection of the proximal aorta is often recommended. However, the specific pattern of aortopathy is highly variable among patients, with different segments of the ascending aorta being affected. Individual patient risks are sometimes difficult to predict. Resection strategies are informed by current surgical guidelines which are primarily based on aortic size and growth criteria. These criteria may not optimally reflect the risk of important aortic events. To address these issues in the care of patients with bicuspid valve aortopathy, our translational research group has focused on validating use of novel imaging techniques to establish non-invasive hemodynamic biomarkers for risk-stratifying BAV patients. In this article, we review recent efforts, successes, and ongoing challenges in the development of more precise and individualized surgical approaches for patients with bicuspid aortic valves and associated aortic disease.

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Comparative Histology of Aortic Dilatation Associated With Bileaflet Versus Trileaflet Aortic Valves

Cited by 31 publications

References 30 publications

Fate of remnant sinuses of Valsalva in patients with bicuspid and trileaflet valves undergoing aortic valve, ascending aorta, and aortic arch replacement

Fate of remnant sinuses of Valsalva in patients with bicuspid and trileaflet valves undergoing aortic valve, ascending aorta, and aortic arch replacement

Year in review

Evolution of Precision Medicine and Surgical Strategies for Bicuspid Aortic Valve-Associated Aortopathy

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