title: Comparison of ascending aortic cohesion between patients with bicuspid aortic valve stenosis and regurgitation.
abstract: OBJECTIVE
  A bicuspid aortic valve (BAV) is commonly associated with aortic wall abnormalities, including dilatation of the ascending aorta and increased potential for aortic dissection. We compared the mechanical properties of the aortic wall of BAV patients with aortic valve stenosis (AS) and regurgitation (AR) using a dissectometer, a device mimicking transverse aortic wall shear stress.
  
  
  METHODS
  Between March 2010 and February 2013, 85 consecutive patients with bicuspid aortic valve undergoing open aortic valve replacement at our institution were prospectively enrolled, presenting either with stenosis (Group 1, n = 58) or regurgitation (Group 2, n = 27). Aortic wall cohesion measured by the dissectometer (Parameters P7, P8 and P9), aortic diameters measured by transoesophageal echocardiography (TOE) and thickness of the wall were compared. One patient presenting with the Marfan syndrome was excluded from the study.
  
  
  RESULTS
  Patients with aortic regurgitation were significantly younger (48.2 ± 15.8 vs 64.7 ± 10.7, P < 0.001), and had a significantly thicker aortic wall (2.30 ± 0.49 mm vs 2.06 ± 0.35 mm, P = 0.029). Transoesophageal echocardiography diameters (annulus, aortic sinuses and sinotubular junction) were significantly larger in the AR group (27.3 ± 3.6 vs 25.5 ± 2.4, P = 0.008; 41.1 ± 7.7 vs 36.7 ± 8.0, P = 0.011; 37.6 ± 9.7 vs 33.8 ± 9.1, P = 0.049). The ascending aortic diameter did not differ (43.2 ± 10.6 vs 40.3 ± 9.1, P = 0.292). Patients with AR had significantly worse aortic cohesion, as measured by shear stress testing (P7: 97.2 ± 45.0 vs 145.5 ± 84.9, P = 0.015; P8: 2.00 ± 0.65 vs 3.82 ± 1.56, P < 0.001; P9: 2.96 ± 0.82 vs 4.98 ± 1.80, P < 0.001) compared with those with AS.
  
  
  CONCLUSIONS
  We observed significantly worse aortic wall cohesion, a thicker aortic wall and a larger aortic root in patients presenting with bicuspid AR compared with patients with AS. These results suggest that bicuspid AR represents a different disease process with possible involvement of the ascending aorta, as demonstrated by dissectometer examination.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West-German Heart Center, University Hospital Essen, University of Duisburg Essen, Essen, Germany jaroslav.benedik@uk-essen.de.
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Benedik
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West-German Heart Center, University Hospital Essen, University of Duisburg Essen, Essen, Germany.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Dohle
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West-German Heart Center, University Hospital Essen, University of Duisburg Essen, Essen, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Wendt
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West-German Heart Center, University Hospital Essen, University of Duisburg Essen, Essen, Germany.
authors.forename: Kevin
authors.initials: K
authors.lastname: Pilarczyk
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West-German Heart Center, University Hospital Essen, University of Duisburg Essen, Essen, Germany.
authors.forename: Vivien
authors.initials: V
authors.lastname: Price
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West-German Heart Center, University Hospital Essen, University of Duisburg Essen, Essen, Germany.
authors.forename: Fanar
authors.initials: F
authors.lastname: Mourad
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West-German Heart Center, University Hospital Essen, University of Duisburg Essen, Essen, Germany.
authors.forename: Elizaveta
authors.initials: E
authors.lastname: Zykina
authors.affiliation: Department of Research on Learning and Instruction, Institute of Educational Science, Ruhr-University Bochum, Bochum, Germany.
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Stebner
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West-German Heart Center, University Hospital Essen, University of Duisburg Essen, Essen, Germany.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Tsagakis
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West-German Heart Center, University Hospital Essen, University of Duisburg Essen, Essen, Germany.
authors.forename: Heinz
authors.initials: H
authors.lastname: Jakob
mesh_terms: D000328:Adult; D000368:Aged; D001011:Aorta / Q000473:pathology / Q000503:physiopathology; D001021:Aortic Valve / Q000002:abnormalities* / Q000503:physiopathology / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000503:physiopathology* / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000503:physiopathology* / Q000601:surgery; D000082882:Bicuspid Aortic Valve Disease; D005260:Female; D006349:Heart Valve Diseases / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
keywords: Aortic wall; Aortic wall cohesion testing; Bicuspid aortic valve; Dissection