Progressive dilation of the diameter of the aortic root in adults with a bicuspid aortic valve

Abstract

Background: To determine the rate of progression of dilation of the aortic root in adults with a bicuspid aortic valve. Methods: We reviewed retrospectively the transthoracic echocardiograms of 50 adults with a bicuspid aortic valve. Each patient had had at least two examinations made 12 months apart. Measurements were taken at four levels: at the basal attachment of the leaflets of the valve within the left ventricular outflow tract, at the widest point of the sinuses of Valsalva, at the sinutubular junction, and in the ascending aorta 1 cm beyond the sinutubular junction. Results: Progressive dilation occurred at all levels, ranging from 0.3 mm/yr at the basal attachment within the left ventricular outflow tract to 1.0 mm/yr, 1 cm beyond sinutubular junction. These rates of dilation were greater than the reported rate of 0.8 mm per decade in the normal population. The rate of dilation found in the ascending aorta 1 cm beyond the sinutubular junction was significantly greater than at the other sites (p = 0.005). The 21 patients with baseline measurements greater than 34 mm had a significantly higher rate of progression (p = 0.007). Sex, age, and the degree of valvar obstruction or regurgitation did not significantly influence the rate of progression of dilation. Conclusion: There is a significantly higher rate of dilation of the aortic root in adults with a bicuspid aortic valve when compared to the normal population. Periodic evaluation of the ascending aorta is essential in these patients, even after replacement of the aortic valve. Other imaging modalities should be considered if the region beyond the sinutubular junction is not well visualized by transthoracic echocardiography.

Echocardiographic anatomy of ascending aorta dilatation: Correlations with aortic valve morphology and function

“…It is worthy of note that mean sinus diameter in the bicuspid subgroup of the present series was 3.8 cm, a normal value for the mean age and body surface of our bicuspid patients. Consistently, in previous studies on younger patients with bicuspid valve the most frequent site of dilatation and the site of maximal annual growth rate was the ascending tract [16,20,21]. From a clinical point of view, our findings could provide a rationale for the high freedom from aortic re-dilatation previously reported in the follow-up after surgical treatment of bicuspid-associated aneurysms using techniques that leave the native root untreated, i.e.…”

Dilatation of the ascending aorta in paediatric patients with bicuspid aortic valve: frequency, rate of progression and risk factors

“…When z scores are calculated for our patients with BAV, our results confirm those of adult studies in that the ascending aorta z score increases over time in patients with BAV. 20 The average rate of change of z score was 0.3928/year. This suggests that, depending on the initial z score, a follow-up interval of 2-4 years is required to detect important changes in the size of the ascending aorta.…”

The ascending aortic aneurysm: When to intervene?

“…In contrast, another study involving 514 patients comparing patients with BAV (70) to patients with TAV(445) showed that patients with BAV had a higher growth rate (0.19 cm/yr compared to 0.14 cm/yr) and higher surgical repair rate than TAV patients (72.8% vs 44.8%). In addition, a recent study at the Montreal Heart Institute showed that ascending aortas in patients with BAV had a growth rate of 0.1 cm per year 1 cm beyond the sinotubular junction [31].…”