title: Aortic medial changes associated with bicuspid aortic valve: myth or reality?
abstract: OBJECTIVE
  To determine whether aortic medial changes are more severe in patients who require aortic valve replacement of congenitally bicuspid aortic valves (BAV) than in patients who require replacement of tricuspid aortic valves and acquired valvular disease (AVD).
  
  
  METHODS
  Aortas from autopsies of 14 patients with BAV and 25 with AVD were histologically assessed by two 'blinded' cardiovascular pathologists and analyzed independently with computer-aided morphometry. The aortic valves were examined for valvular fibrosis and calcification.
  
  
  METHODS
  The patient population was from a tertiary-care facility.
  
  
  METHODS
  Patients were selected by retrospective review of autopsy records for patient deaths after aortic valve replacement, over the period 1984 to 1995.
  
  
  RESULTS
  There were no significant differences in age (P=0.89), sex (P=0.94), prevalence of systemic arterial hypertension (P=0.37), valvular degenerative changes (P=0.10 and P=1.0) or heart weights (P=0.60) between the two groups. Histological scores for aortic medial degenerative changes including elastic fragmentation, fibrosis and medionecrosis were not statistically different between the groups. However, morphometry demonstrated less elastic tissue in patients with BAV (P=0.003).
  
  
  CONCLUSIONS
  Routine microscopy shows no significant difference in the degree of aortic medial degenerative changes between patients with BAV and AVD. However, morphometry shows less elastic tissue in the aortas of BAV patients. This may explain the anecdotal increase in aortic fragility and propensity for aortic dissection in these patients.
authors.affiliation: Ottawa Hospital, Ottawa, Canada.
authors.forename: J L
authors.initials: JL
authors.lastname: Parai
authors.forename: R G
authors.initials: RG
authors.lastname: Masters
authors.forename: V M
authors.initials: VM
authors.lastname: Walley
authors.forename: W A
authors.initials: WA
authors.lastname: Stinson
authors.forename: J P
authors.initials: JP
authors.lastname: Veinot
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000473:pathology*; D001021:Aortic Valve / Q000002:abnormalities* / Q000473:pathology / Q000601:surgery; D002102:Cadaver; D002114:Calcinosis / Q000473:pathology; D005260:Female; D005355:Fibrosis; D006349:Heart Valve Diseases / Q000151:congenital* / Q000473:pathology; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D010784:Photomicrography; D012189:Retrospective Studies