title: Aortopathy and bicuspid aortic valve: haemodynamic burden is main contributor to aortic dilatation.
abstract: OBJECTIVE
  To evaluate factors associated with aortic enlargement in patients with a bicuspid aortic valve (BAV) and the impact of isolated aortic valve replacement (AVR).
  
  
  METHODS
  A retrospective analysis of clinical data in a tertiary referral hospital.
  
  
  METHODS
  We performed a cross-sectional analysis of 595 patients with BAV to assess variables determining maximal ascending aortic dimension. To measure annual dilatation rates, baseline and follow-up echocardiograms were analysed in 70 patients with BAV (BAV-AVR group) and 48 with a tricuspid aortic valve (TVA-AVR group) who underwent isolated AVR, and compared with 65 patients with BAV who did not undergo AVR (BAV-NAVR group).
  
  
  RESULTS
  Aortic regurgitation (AR) severity was associated with aortic sinus diameter (p<0.001), whereas aortic stenosis severity with the tubular diameter (p<0.001). Multivariate analysis showed that age was an independent factor for both sinus and tubular diameter with AR severity being for aortic sinus diameter and moderate to severe aortic stenosis or AR being for aortic tubular diameter. Despite younger age and lower prevalence of moderate to severe valvular dysfunction at baseline, the annual dilatation rates at sinus and tubular part were significantly higher in the BAV-NAVR than in the BAV-AVR and TAV-AVR groups (p<0.05 each), which did not differ in the BAV-AVR and TAV-AVR groups (p=0.402 for sinus and p=0.394 for tubular part).
  
  
  CONCLUSIONS
  Age-dependent aortic enlargement associated with significant valvular dysfunction and the protective effects of isolated AVR in patients with BAV indicate that valvular dysfunction is a major determinant to the development of aortopathy.
authors.affiliation: Cardiac Imaging Center, Asan Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: Yong-Giun
authors.initials: YG
authors.lastname: Kim
authors.forename: Byung Joo
authors.initials: BJ
authors.lastname: Sun
authors.forename: Gyung-Min
authors.initials: GM
authors.lastname: Park
authors.forename: Seungbong
authors.initials: S
authors.lastname: Han
authors.forename: Dae-Hee
authors.initials: DH
authors.lastname: Kim
authors.forename: Jong-Min
authors.initials: JM
authors.lastname: Song
authors.forename: Duk-Hyun
authors.initials: DH
authors.lastname: Kang
authors.forename: Jae-Kwan
authors.initials: JK
authors.lastname: Song
mesh_terms: D000328:Adult; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000503:physiopathology*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D001018:Aortic Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001021:Aortic Valve / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000503:physiopathology; D000082882:Bicuspid Aortic Valve Disease; D003430:Cross-Sectional Studies; D018450:Disease Progression; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index