Managing Thoracic Aortic Aneurysm in Patients with Bicuspid Aortic Valve Based on Aortic Root-Involvement

Norton, Elizabeth L.; Yang, Bo

doi:10.3389/fphys.2017.00397

Cited by 21 publications

(17 citation statements)

References 38 publications

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“…Bicuspid aortic valve (BAV) is associated with aortic dilation, 1 with up to 50% of patients with BAV developing ascending aortic aneurysms (AsAAs). 2 This is attributed to altered hemodynamics resulting in an eccentric helical flow pattern. 3 , 4 Hemodynamics coupled with genetic or developmental defects are implicated in aberrant remodeling of the aortic wall relative to individuals with a tricuspid aortic valve (TAV).…”

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confidence: 99%

Bicuspid valve aortopathy is associated with distinct patterns of matrix degradation

Chim

Davies

Mason

et al. 2020

The Journal of Thoracic and Cardiovascular Surgery

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Objective: To explore the micromechanical, biochemical, and microstructural differences between bicuspid aortic valve aneurysm (BAV-A) and tricuspid aortic valve idiopathic degenerative aneurysm (DA), compared with normal aorta. Methods: Aortic tissue was obtained from patients undergoing aneurysmal repair surgery (BAV-A; n ¼ 15 and DA; n ¼ 15). Control tissue was obtained from aortic punch biopsies during coronary artery bypass graft surgery (n ¼ 9). Nanoindentation was used to determine the elastic modulus on the medial layer. Glycosaminoglycan, collagen, and elastin levels were measured using biochemical assays. Verhoeff Van Gieson-stained cross-sections were imaged for elastin microstructural quantification. Results: The elastic modulus was more than 20% greater for BAV-A relative to control and DA (signifying a loss of compliance). No significance difference between control and DA were observed. Collagen levels for BAV-A (36.9 AE 7.4 mg/mg) and DA (49.9 AE 10.9 mg/mg) were greater compared with the control (30.2 AE 13.1 mg/mg). Glycosaminoglycan and elastin levels were not significant between the groups. Elastin segments were uniform throughout the control. Aneurysmal tissues had less elastin segments close to the intima and adventitia layers. Both BAV-A and DA had elastin segments compacted in the media; however, elastin segments were highly fragmented in DA. Conclusions: BAV-A has a greater loss of aortic wall compliance relative to DA and the control. Although elastin levels were equal for all groups, spatial distribution of elastin provided a unique profile of matrix degradation for BAV-A. Elastin compaction within the media of BAV-A may have resulted from the altered hemodynamic pressure against the wall, which could explain for the stiffness of the tissue.

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confidence: 99%

Bicuspid valve aortopathy is associated with distinct patterns of matrix degradation

Chim

Davies

Mason

et al. 2020

The Journal of Thoracic and Cardiovascular Surgery

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“…However, AoR dilation may be an inherent form of BAV associated disease and a heterogeneous disease compared with tubular mid-ascending aortic dilatation, confirming the speculation of Cotrufo et al 16) Aortic annulus enlargement that responses to AoR stretch occur in AoR dilation, leading to AR. 18) The heterogeneity of BAV aortopathy was elaborated by Norton et al, 19) and they believed that AoR dilation and AR should be treated more aggressively during surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Both inherent disposition and abnormal hemodynamics were proved as criminals in the development of BAV-associated aortic dilatation, the different specific phenotypes of aortic dilation may be dominated by one main factor, and others (even some unknown reasons) are accomplices. 5,16,19) Our dominance analysis may imply that (1) inherent disposition was mainly responsible for the higher frequency of AoR+AAo dilation and lower prevalence of AAo+PArc dilation in patients of Type-1 LR with AR or AS+AR; (2) in patients with Type-0 LAT and AS, valve-related hemodynamics may be the determinant for the bias prevalence of different types of aortic dilation (more AAo+PArc and less AoR+AAo), and (3) the higher prevalence of AAo dilation may be attributed to both of above two variables in patients with Type-1 LR and AS.…”

Section: Discussionmentioning

confidence: 99%

The Heterogeneous Phenotype of Bicuspid Aortopathy Attribute to Different Dominant Pathogenesis

Huang

Wang

et al. 2019

ATCS

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Purpose: Our study aimed to investigate the potential pathogenetic theories of different phenotype prevalence in bicuspid aortopathy.Methods: A total of 407 bicuspid aortic valve (BAV) patients with aortic dilation were retrospectively reviewed. Association was determined between aortic valve lesion types and aortic configurations to confirm the homogeneous BAV subsets, and then, dominance analysis was used to evaluate the relative importance of two components of aortic valve lesion (BAV phenotype and valvular dysfunction) that associated with aortic configurations in each subgroup.Results: Dominance analysis showed that Type-1 LR was the dominant contributor (79.0% and 79.6%) associated with the higher prevalence of the dilation of aortic root (AoR) and ascending aorta (AAo) in BAV patients with Type-1 LR and aortic regurgitation (AR) or aortic stenosis (AS) + AR. However, AS was the main contributor (60.0%) associated with the raised incidence of the dilation of AAo and proximal aortic arch (PArc) in Type-0 LAT and AS.Conclusions: Different dominant pathogenetic theory determined the phenotype of BAV aortopathy. In patients of Type-1 LR with AR, inherent disposition is mainly responsible for the higher frequency of AoR dilation. Valve-related hemodynamics determined greater prevalence of the dilation of AAo and PArc in patients of Type-0 LAT with AS.

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“…European Society of Cardiology guidelines recommend that surgery should be performed in patients with a bicuspid aortic valve with a maximal diameter ≥55 mm 56. Meanwhile, however, Norton and Yang7 have emphasized the importance of aortic root phenotype in bicuspid aortic valve and have suggested that diameters of the root exceeding 45 mm should be indications for surgery.…”

Section: Introductionmentioning

confidence: 99%

Concomitant Wrapping of a Moderately Dilated Ascending Aorta during Aortic Valve Replacement: Postoperative Remodeling of a Distinctive Aorta

Kim

Lee

et al. 2020

Yonsei Med J

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PurposeThe long-term outcomes of aortic wrapping in patients with ascending aortic aneurysms, which are rare, but can be fatal, remain poorly understood. This retrospective study analyzed the outcomes of aortic diameter, including aortic root, ascending aorta, and proximal arch diameters, after aortic wrapping during aortic valve replacement surgery.Materials and MethodsNinety-six patients with ascending aortic dilation of 40–55 mm who underwent aortic wrapping during aortic valve replacement were selected for this study. Aortic diameter was measured at three levels perioperatively and at follow-up (median time of 9.1±4.2 years). A linear mixed-effects model was used to analyze aortic diameter expansion.ResultsFreedom from adverse aortic events (aortic dissection or rupture, reoperation, or sudden death) at 10 years was 97.9%. No significant dilation at the level of the sinuses of Valsalva (0.069 mm/year, p=0.524) or ascending aorta (0.152 mm/year, p=0.124) was observed. Significant dilation occurred at the proximal aortic arch (0.343 mm/year, p=0.006). Subgroup analysis with a multivariable linear mixed model identified initial ascending aortic diameter to be a significant predictor of proximal arch dilation (p=0.032). Receiver operating characteristic curve analysis revealed that the cut-off for the prediction of proximal arch redilation was an initial mid-ascending aortic diameter of 47.0 mm (area under the curve 0.747, 90% confidence interval 0.613–0.881, p=0.023).ConclusionAortic wrapping could be considered as a safe and long-term therapeutic option. Redilation of the proximal arch should be carefully observed during long-term follow-up.

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Managing Thoracic Aortic Aneurysm in Patients with Bicuspid Aortic Valve Based on Aortic Root-Involvement

Cited by 21 publications

References 38 publications

Bicuspid valve aortopathy is associated with distinct patterns of matrix degradation

Bicuspid valve aortopathy is associated with distinct patterns of matrix degradation

The Heterogeneous Phenotype of Bicuspid Aortopathy Attribute to Different Dominant Pathogenesis

Concomitant Wrapping of a Moderately Dilated Ascending Aorta during Aortic Valve Replacement: Postoperative Remodeling of a Distinctive Aorta

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