title: Comparison of the structure of the aortic valve and ascending aorta in adults having aortic valve replacement for aortic stenosis versus for pure aortic regurgitation and resection of the ascending aorta for aneurysm.
abstract: BACKGROUND
  There is debate concerning whether an aneurysmal ascending aorta should be replaced when associated with a dysfunctioning aortic valve that is to be replaced. To examine this issue, we divided the patients by type of aortic valve dysfunction-either aortic stenosis (AS) or pure aortic regurgitation (AR)-something not previously undertaken.
  
  
  RESULTS
  Of 122 patients with ascending aortic aneurysm (unassociated with aortitis or acute dissection), the aortic valve was congenitally malformed (unicuspid or bicuspid) in 58 (98%) of the 59 AS patients, and in 38 (60%) of the 63 pure AR patients. Ascending aortic medial elastic fiber loss (EFL) (graded 0 to 4+) was zero or 1+ in 53 (90%) of the AS patients, in 20 (53%) of the 38 AR patients with bicuspid valves, and in all 12 AR patients with tricuspid valves unassociated with the Marfan syndrome. An unadjusted analysis showed that, among the 96 patients with congenitally malformed valves, the 38 AR patients had a significantly higher likelihood of 2+ to 4+ EFL than the 58 AS patients (crude odds ratio: 8.78; 95% confidence interval: 2.95, 28.13).
  
  
  CONCLUSIONS
  These data strongly suggest that the type of aortic valve dysfunction-AS versus pure AR-is very helpful in predicting loss of aortic medial elastic fibers in patients with ascending aortic aneurysms and aortic valve disease.
authors.affiliation: Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX 75246, USA. wc.roberts@baylorhealth.edu
authors.forename: William Clifford
authors.initials: WC
authors.lastname: Roberts
authors.forename: Travis James
authors.initials: TJ
authors.lastname: Vowels
authors.forename: Jong Mi
authors.initials: JM
authors.lastname: Ko
authors.forename: Giovanni
authors.initials: G
authors.lastname: Filardo
authors.forename: Robert Frederick
authors.initials: RF
authors.lastname: Hebeler
authors.forename: Albert Carl
authors.initials: AC
authors.lastname: Henry
authors.forename: Gregory John
authors.initials: GJ
authors.lastname: Matter
authors.forename: Baron Lloyd
authors.initials: BL
authors.lastname: Hamman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000473:pathology* / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery*; D001021:Aortic Valve / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001794:Blood Pressure / Q000502:physiology; D004547:Elastic Tissue / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology; D009929:Organ Size / Q000502:physiology; D012189:Retrospective Studies; D013599:Systole / Q000502:physiology; D014261:Tricuspid Valve / Q000473:pathology