Bicuspid aortic valve leaflet morphology in relation to aortic root morphology: a study of 300 patients undergoing open-heart surgery
Bicuspid aortic valve leaflet morphology in relation to aortic root morphology: a study of 300 patients undergoing open-heart surgery
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DOI：
10.1016/j.ejcts.2011.04.014
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发表时间：
2011-09-01
影响因子：
3.4
通讯作者：
Franco-Cereceda, Anders
中科院分区：
文献类型：
--
作者：
Jackson, Veronica;Petrini, Johan;Franco-Cereceda, Anders
目的：关于二尖瓣病变(BAV)患者主动脉扩张的机制，目前仍有争论，即这是一种血流动力学效应，还是与先天性的主动脉壁薄弱有关？这项研究评估了BAV形态与升主动脉形态相关的可能性，因为这种相关性将强化血流动力学改变导致主动脉扩张的观点。方法：应用超声心动图对300例因主动脉瓣和/或升主动脉疾病住院患者的升主动脉形态进行评价，并结合外科医生对主动脉瓣的检查。结果：三尖瓣病变(TAV)130例，BAV病变160例，单瓣病变(UAV)10例。升主动脉瘤在腹主动脉瘤患者中比腹主动脉瘤患者更常见(分别为36%和12%；p<；0.001)，而主动脉扩张同样常见(两组均为8%)。主动脉瓣狭窄或返流在主动脉正常的TAV和BAV患者中分布均匀(p=0.82)。当主动脉扩张时，主动脉狭窄主要与主动脉瓣静脉相关(BAV56%，TAV4%；P<；0.001)，而主动脉瓣返流更常见于TAV(TAV81%，BAV29%；P<；0.001)。在脑动静脉畸形患者中，右冠状动脉和左冠状动脉尖端融合占主导地位(74%)，其次是右冠脉和非冠脉尖端融合(14%)和真右冠脉和左冠脉尖端融合(11%)(P<；0.001)。升主动脉瘤或升主动脉扩张症在所有形态不同的BAV中的相对分布相似(p=0.95)。结论：在我们的研究人群中，50%的手术患者有二尖瓣。主动脉瘤在BAV患者中比TAV患者更常见。主动脉内径正常的TAV和BAV均以主动脉狭窄和主动脉瓣关闭不全为主，而主动脉扩张的TAV和BAV的主动脉狭窄以主动脉瓣关闭不全为主。无论BAV叶的形态如何，主动脉扩张的分布相似。这些发现支持了BAV患者主动脉扩张的内在机制的观点。(C)2011年欧洲胸心外科协会。爱思唯尔出版，版权所有。
Objective: There is an ongoing discussion regarding the mechanism of aortic dilatation in bicuspid aortic valve (BAV) disease, that is, is this a hemodynamic effect or related to an inborn weakness of the aortic wall? This study evaluated the possibility of BAV morphology being related to ascending aorta morphology as such a correlation would strengthen the idea that hemodynamic alterations cause the dilatation of the aorta. Methods: The morphology of the ascending aorta of 300 patients admitted for aortic valve and/or ascending aorta disease was evaluated by echocardiography and related to the surgeon's inspection of the aortic valve. Results: A tricuspid aortic valve (TAV), BAV, or unicuspid aortic valve (UAV) was present in 130, 160, and 10 patients, respectively. Ascending aortic aneurysm was more common in patients with BAV compared with TAV (36% and 12%, respectively; p < 0.001), while ectasia of the aorta was similarly common (8% in both groups). Aortic stenosis or regurgitation was equally distributed in TAV and BAV patients with normal aortas (p = 0.82). When the aorta was dilated, aortic stenosis was predominantly associated with BAV (BAV 56%, TAV 4%; p < 0.001), while aortic regurgitation was more common in TAV (TAV 81%, BAV 29%; p < 0.001). In BAV patients, fusion of the right-and left coronary cusp was predominant (74%) followed by right-and non-coronary cusp fusion (14%) and true BAV (fusion of the right-and left coronary cusp without remnant raphe; 11%) (p < 0.001). The relative distribution of ascending aortic aneurysm or ectasia was similar in all morphologically different BAV (p = 0.95). Conclusions: In our study population, >50% of the patients admitted for surgery had a bicuspid valve. Aortic aneurysm was more common in BAV than in TAV patients. Aortic stenosis and aortic regurgitation were equally common in TAV and BAV with normal aortic dimensions, while aortic regurgitation was predominant in TAV with dilated aortas and aortic stenosis in BAV with dilated aortas. Dilatation of the aorta was similarly distributed regardless of BAV leaflet morphology. These findings support the idea of an intrinsic mechanisms underlying dilatation of the aorta in BAV patients. (C) 2011 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.