Failure to prevent progressive dilation of ascending aorta by aortic valve replacement in patients with bicuspid aortic valve: comparison with tricuspid aortic valve.
BACKGROUND
Patients with bicuspid aortic valve (BAV) have been frequently complicated with ascending aortic dilation possibly because of hemodynamic burdens by aortic stenosis (AS) or regurgitation (AR) or congenital fragility of the aortic wall.


RESULTS
To clarify if the aortic dilation could be prevented by aortic valve replacement (AVR) in BAV patients, we studied 13 BAV (8 AR dominant, 5 AS dominant) and 14 tricuspid aortic valve (TAV) patients (7 AR, 7 AS) by echocardiography before and after AVR (9.7+/-4.8 years). We also studied 18 BAV (11 AR, 7 AS) without AVR. Diameters of the sinuses of Valsalva, sinotubular junction and the proximal aorta were measured. The annual dilation rate was calculated by dividing changes of diameters during the follow-up period by the body surface area and the observation interval. We found that aortic dilation in BAV patients tended to be faster than that in TAV patients, although a significant difference was found only at the proximal aorta (0.18+/-0.08 versus -0.08+/-0.08 mm/(m2/year), P=0.03). BAV patients with and without AVR showed similar progressive dilation. AR dominant group showed tendency of more progressive dilation than AS dominant group in BAV, although it did not reach statistical significance. TAV patients did not show further aortic dilation after AVR.


CONCLUSIONS
AVR could not prevent progressive aortic dilation in BAV. Since the aorta did not dilate in TAV, progressive aortic dilation in BAV seems mainly due to the fragility of the aortic wall rather than hemodynamic factors.
Yasuda
Hisayo
H
Department of Cardiology, National Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan.
Nakatani
Satoshi
S
Stugaard
Marie
M
Tsujita-Kuroda
Yuko
Y
Bando
Ko
K
Kobayashi
Junjiro
J
Yamagishi
Masakazu
M
Kitakaze
Masafumi
M
Kitamura
Soichiro
S
Miyatake
Kunio
K
D000328:Adult; D001018:Aortic Diseases / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D001021:Aortic Valve / Q000002:abnormalities* / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000150:complications; D001024:Aortic Valve Stenosis / Q000150:complications; D004108:Dilatation, Pathologic / Q000209:etiology / Q000517:prevention & control; D018450:Disease Progression; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure