Aortic medial changes associated with bicuspid aortic valve: myth or reality?
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.
Parai
J L
JL
Ottawa Hospital, Ottawa, Canada.
Masters
R G
RG
Walley
V M
VM
Stinson
W A
WA
Veinot
J P
JP
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