The Association Between Aortic Valve Leaflet Morphology and Patterns of Aortic Dilation in Patients With Bicuspid Aortic Valves

Ruzmetov, Mark; Shah, Jitendra J.; Fortuna, Randall S.; Welke, Karl F.

doi:10.1016/j.athoracsur.2015.02.036

Cited by 40 publications

(34 citation statements)

References 24 publications

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“…In doing so, we hoped to provide potential further insight into the cause of aortic dilation in patients with BAV and to identify patient parameters associated with aortic dilation. As previously described in other cohorts [3, 16, 18–23], we observed BAV patients with R–L phenotype have marginally greater aortic root dimensions than patients with R–NC morphotype, and may therefore be at greater risk of requiring surgery [24]. However, prior studies have not been in agreement with these findings [25–29].…”

Section: Discussionsupporting

confidence: 77%

Association between bicuspid aortic valve morphotype and regional dilatation of the aortic root and trunk

Habchi

Ashikhmina

Vieira

et al. 2016

Int J Cardiovasc Imaging

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Thoracic aortic disease, including thoracic aortic aneurysm (TAA), is frequently seen in patients with bicuspid aortic valve (BAV). We hypothesized that BAV morphotype would be associated with aortic aneurysm phenotypes but that other patient variables would significantly modify this relationship. 829 patients between 18 and 90 years with BAV and available raw imaging of the aortic valve and the ascending aorta to its mid-portion prior to aortic valve and aortic surgery were examined. The sinuses of Valsalva and proximal ascending aorta were measured from 2-dimensional co-planar echocardiographic images. We observed strong associations between patient habitus and raw and normalized dimensions of the aortic root and ascending aorta. Patients with R-L morphotype presented at an older age with larger aortic root but similar ascending aortic dimensions. After accounting for patient morphometric characteristics and severity of aortic valve disease, patients with R-L valve morphotype were marginally more likely to have an aortic root aneurysm (86% vs. 78%; P = 0.043), defined as aortic root dimension Z score ≥3. We observed only small differences in aortic dimensions between BAV morphotypes, that are eclipsed by variation in patient habitus. We interpret these findings to mean that BAV patients will not likely benefit from therapies based on aortic valve morphotype. Rather, we propose that all BAV patients should undergo longitudinal follow-up, independent of valve morphotype. Guidelines for aortic surgery based upon dimensions alone may be improved by considering patient characteristics such as age, body size and other characteristics.

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Section: Discussionsupporting

confidence: 77%

Association between bicuspid aortic valve morphotype and regional dilatation of the aortic root and trunk

Habchi

Ashikhmina

Vieira

et al. 2016

Int J Cardiovasc Imaging

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“…A few studies have addressed the impact of phenotypic variability on postoperative growth of the aorta and aortic-related event after AVR. [4][5][6][7] In Japanese patients, however, no study has addressed this issue. The purpose of the present retrospective longitudinal Postoperative Aortic Dilatation in BAV were those in which the patient was found dead within 24 h of having last been seen alive and in a normal state of health.…”

Section: Methodsmentioning

confidence: 99%

Valve Phenotype and Risk Factors of Aortic Dilatation After Aortic Valve Replacement in Japanese Patients With Bicuspid Aortic Valve

Kinoshita

Naito

Suzuki

et al. 2016

Circ J

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Background:The aim of this study was to assess the risk factors for dilatation of the aorta over time in Japanese patients with bicuspid aortic valve (BAV) undergoing aortic valve replacement (AVR), focusing on the possible impact of valve fusion phenotype. Methods and Results:Of 167 BAV patients undergoing AVR (24% of overall AVR patients, n=702), 135 patients in whom surgical intervention for the aorta was not undertaken were focused on (74 had right-left fusion and 61 non-right-left fusion type). During a mean follow up of 5.2 years, aortic growth rate (mm/year) of the ascending aorta was similar between the valve phenotype. In multivariate logistic regression, the presence of aortic regurgitation > moderate was significantly associated with a rapid dilatation of the ascending aorta, defined as >0.7 mm/year (odds ratio 2.1, 95% confidence interval 1.2-3.7, P=0.03). Independent predictors of dilatation of the aorta up to more than 45 mm were: a diameter of the ascending aorta >40 mm at the time of surgery (odds ratio 3.7, 95% confidence interval 1.2-11.4, P=0.02) and length of follow up (odds ratio 1.3-increase per year, 95% confidence interval 1.0-1.5, P=0.04). Conclusions:The presence of aortic regurgitation and the ascending aorta of >40 mm at the time of surgery emerged as significant predictors of dilatation of the aorta after AVR but valve fusion phenotype was not. (Circ J 2016; 80: 1356 -1361

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“…Provider variance contributed, albeit modestly, to practice variation, and may be partly explained by inconsistent data regarding risk factors for aortic valve dysfunction and aortic dilation. In fact, data regarding whether BAV morphology, AS, and AR are risk factors for aortic dilation and aortic valve dysfunction are conflicting in prior reports . This study showed that BAV morphology and the degree of AS or AR at the time of initial encounter were unrelated to aortic dilation.…”

Section: Discussionmentioning

confidence: 50%

“…Therefore, extrapolation from adult guidelines may lead to more frequent than necessary follow‐up encounters and inappropriate use of cardiac imaging. Targeting children with higher risk for disease progression is limited by conflicting reports regarding the influences of BAV morphology and aortic valve dysfunction on aortic dilation . The aims of this study are to assess the disease progression of an isolated BAV during childhood and to assess associations between disease progression and current management practices (follow‐up intervals and frequency of cardiac imaging).…”

Section: Introductionmentioning

confidence: 99%

Disease progression and variation in clinical practice for isolated bicuspid aortic valve in children

Yamauchi

Puchalski

Weng

et al. 2018

Congenital Heart Disease

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The Association Between Aortic Valve Leaflet Morphology and Patterns of Aortic Dilation in Patients With Bicuspid Aortic Valves

Cited by 40 publications

References 24 publications

Association between bicuspid aortic valve morphotype and regional dilatation of the aortic root and trunk

Association between bicuspid aortic valve morphotype and regional dilatation of the aortic root and trunk

Valve Phenotype and Risk Factors of Aortic Dilatation After Aortic Valve Replacement in Japanese Patients With Bicuspid Aortic Valve

Disease progression and variation in clinical practice for isolated bicuspid aortic valve in children

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