title: Factors affecting a dilated ascending aorta in patients with bicuspid aortic valve: the relevance of valve anatomy, body size and age.
abstract: OBJECTIVE
  Information regarding the appropriate management of patients with moderately dilated ascending aortas is limited. We investigated factors affecting ascending aortic dilatation in BAV patients, such as anatomy, body size and age.
  
  
  METHODS
  We evaluated 130 patients with BAV (age, 59.9 ± 16.1 years; body surface area (BSA), 1.58 ± 0.20 m(2)) who underwent aortic valve surgery. The cusp configuration was determined according to the presence and location of the raphe and the cusp direction. The ascending aortic diameter index (AADI) was calculated using computed tomography and the BSA.
  
  
  RESULTS
  Sixty-four patients had A-P-type BAV, while 66 had R-L-type BAV. The mean ascending aorta diameter was 42.6 ± 6.7 mm, and the mean AADI was 27.1 ± 5.6 mm/m(2). Based on the AADI, cusp configuration (R-L-BAV: 28.3 ± 6.0 mm/m(2) vs.
  25.8 ± 4.9 mm/m(2), P < 0.05), a female gender, age and the presence of aortic stenosis were found to be related to ascending aortic dilatation, while the mean ascending aortic diameter did not differ between the groups. Among the elderly patients, an AADI greater than 28 mm/m(2) was more frequently observed in the R-L-BAV group than in the A-P-BAV group. Ascending aortic replacement was required after 10 years in two patients with R-L-BAV and no patients with A-P-BAV.
  
  
  CONCLUSIONS
  The relative ascending aortic diameter helped to identify patients with BAV with a risk of dilatation, indicating that the use of ascending aortic replacement should be considered more frequently in patients with R-L-type BAV, while the procedure is avoidable in elderly patients with A-P-type BAV.
authors.affiliation: Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-Oka, Suita, Osaka, 565-0871, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nishi
authors.forename: Taichi
authors.initials: T
authors.lastname: Sakaguchi
authors.forename: Shigeru
authors.initials: S
authors.lastname: Miyagawa
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Yoshikawa
authors.forename: Satsuki
authors.initials: S
authors.lastname: Fukushima
authors.forename: Daisuke
authors.initials: D
authors.lastname: Yoshioka
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Ueno
authors.forename: Toru
authors.initials: T
authors.lastname: Kuratani
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Sawa
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000473:pathology* / Q000601:surgery; D001021:Aortic Valve / Q000002:abnormalities* / Q000473:pathology / Q000601:surgery; D000082882:Bicuspid Aortic Valve Disease; D019917:Blood Vessel Prosthesis Implantation; D049628:Body Size; D002648:Child; D004108:Dilatation, Pathologic; D005260:Female; D006349:Heart Valve Diseases / Q000145:classification / Q000473:pathology* / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012306:Risk; D055815:Young Adult