Abstract
The ascending aorta dilatation in the bicuspid aortic valve (BAV) patients is often attributed to congenital abnormalities of the aortic wall, but it may be related to hemodynamic disturbances in the course of BAV disease. At present, ascending aortic diameter is used as almost sole but weak predictor of aortic dissection and rupture in BAV. We examined the association between aortic wall mechanics and severity of aortic valve disease including different cusps fusion patterns using conventional echocardiography and tissue Doppler imaging (TDI). We prospectively studied 106 BAV patients: 72 with right-left (R-L) coronary cusp fusion were matched 1:1 to 34 patients with right-noncoronary (R-N) cusp fusion obtaining 34 pairs of patients. Peak systolic radial velocity and acceleration of the ascending aortic wall, measured by TDI, were used as an index of hemodynamic stress imposed on the aorta. Paired analysis showed higher aortic wall radial velocity (4.71 ± 1.61 cm/s vs. 3.33 ± 1.44 cm/s, p = 0.001) and acceleration (1.08 ± 0.46 m/s2 vs. 0.80 ± 0.34 m/s2, p = 0.015) in-R-L compared to R-N fusion. Pearson correlation showed association of ascending tubular aortic diameter with age (r = 0.258, p = 0.012), weight (r = 0.323, p = 0.001), peak aortic valve gradient (r = 0.386, p = 0.0001), aortic root diameter (r = 0.439, p < 0.0001), and R-N fusion pattern (r = 0.209, p = 0.043). Aortic root diameter was related to male gender (r = 0.296, p = 0.003), weight (r = 0.381, p = 0.0001), ascending aortic diameter (r = 0.439, p < 0.0001), and severity of aortic regurgitation (r = 0.337, p = 0.0009). Regional differences in aortic wall motion between different BAV cusp fusion patterns and association of aortic diameters with the severity of aortic valve disease, both suggest a deleterious hemodynamic impact of cusp fusion patterns and aortic valve dysfunction on ascending aortic wall. Assessment of aortic hemodynamic by TDI is feasible and could be potentially used to improve prediction of acute aortic complications, thus helping to establish optimal timing of aortic surgery in BAV patients.
Highlights
Bicuspid aortic valve (BAV) is the commonest congenital heart defect in adults, occurring in 1–2% of the population, more frequently in men [1]
The results of a subsequent, larger echocardiographic and magnetic resonance imaging (MRI) flow sensitive studies on BAV, suggest that disturbed flow generated by abnormal aortic valve imposes an increased hemodynamic load on the ascending aortic wall leading to the progressive aortic dilatation [8, 9]
An increased severity of the aortic stenosis, more dilated ascending aorta, but a lower peak systolic radial velocity and velocity acceleration of the anterior ascending aortic wall were observed in patients with right-noncoronary versus right-left coronary cusp fusion (Table 1)
Summary
Bicuspid aortic valve (BAV) is the commonest congenital heart defect in adults, occurring in 1–2% of the population, more frequently in men [1]. BAV is associated with an increased incidence of aortic stenosis and regurgitation, coarctation of the aorta, and ascending aortic dilatation, which may lead to aortic dissection and rupture [2, 3]. Ascending aortic dilatation and aneurysm formation is a characteristic feature of BAV. Echocardiographic studies have reported that ascending aortic dilatation is out of proportion to the severity of aortic valve disease, suggesting intrinsic abnormalities of the aortic wall [6, 7]. The results of a subsequent, larger echocardiographic and magnetic resonance imaging (MRI) flow sensitive studies on BAV, suggest that disturbed flow generated by abnormal aortic valve imposes an increased hemodynamic load on the ascending aortic wall leading to the progressive aortic dilatation [8, 9]
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