Abstract
BackgroundHistopathological changes in the ascending aorta wall in patients with severe tricuspid aortic valve (TAV) stenosis were graded and correlated to echocardiographic parameters. Objective was to associate threshold echocardiographic values with structural defects in the ascending aorta providing a tool to improve decision-making process in cases when simultaneous aortic valve replacement (AVR) and ascending aorta replacement is considered.MethodsBiopsies from 108 TAV stenosis patients subjected to AVR were graded into three grades according to severity of aortic wall changes. Echocardiographic parameters obtained preoperatively and correlated to grade, age, gender and risk factors, were diameters of ventriculo-aortic junction (AA), sinus Valsalva (SV), sinotubular junction (STJ), the largest diameter of the visualized ascending aorta (AscA) as well as indexes: sinus Valsalva (SVI), sinotubular junction (STJI), AscA/AA and STJ/AA.ResultsTwo echocardiographic parameters portrayed grades with statistical significance: STJ (F = 5.417; p = 0.006 (p < 0.05)) and AscA (F = 3.924; p = 0.023 (p < 0.05)). By using multiple predictors in the setting of Regression analysis, statistically significant differences among grades were reached for AA, SV, STJ, AscA and SVI. With further ROC curves analysis, threshold values for different grades were recognized. Grade 2 is identified in patients with AscA > 3.3 cm, while Grade 3 is identified in patients with values of AscA > 3.5 cm, STJ > 2.9 cm and STJI > 1.ConclusionsHemodynamic stress induced by TAV stenosis leads to elastic lamellae disruption in the aortic wall. Those changes could be graded and correlated with echocardiographic parameters of the aortic root and ascending aorta, providing a tool for decision to replace ascending aorta concomitantly with AVR.
Highlights
Histopathological changes in the ascending aorta wall in patients with severe tricuspid aortic valve (TAV) stenosis were graded and correlated to echocardiographic parameters
In the present study, we investigated the spectrum of structural changes in the ascending aortic wall in patients with severe degenerative, calcific aortic stenosis of the tricuspid aortic valve (TAV), and correlated them to echocardiographic parameters
Statistical significance was confirmed with ANOVA among echocardiographic parameters of different grades for sinotubular junction (STJ) (F = 5.417; p = 0.006 (p < 0.05)) and ascending aorta (AscA) (F = 3.924; p = 0.023 (p < 0.05)) (Table 2 and Fig. 2)
Summary
Histopathological changes in the ascending aorta wall in patients with severe tricuspid aortic valve (TAV) stenosis were graded and correlated to echocardiographic parameters. We investigated the spectrum of structural changes in the ascending aortic wall in patients with severe degenerative, calcific aortic stenosis of the tricuspid aortic valve (TAV), and correlated them to echocardiographic parameters. The influence of severe TAV stenosis on structural changes in the wall of ascending thoracic aorta. Definition of irreversible changes in the ascending aorta wall in patients with severe aortic stenosis, Correlation of histological grades with echocardiographic parameters in order to obtain reliable insight into the aortic wall structure by means of non-invasive diagnostics. The answers to issues are complex because aortic stenosis and hemodynamic derangement that it causes, is not the only factor influencing the structure of the ascending aorta. We analyzed are there any gender-related differences in the remodeling process
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