title: Association between bicuspid aortic valve morphotype and regional dilatation of the aortic root and trunk.
abstract: Thoracic aortic disease, including thoracic aortic aneurysm (TAA), is frequently seen in patients with bicuspid aortic valve (BAV). We hypothesized that BAV morphotype would be associated with aortic aneurysm phenotypes but that other patient variables would significantly modify this relationship. 829 patients between 18 and 90 years with BAV and available raw imaging of the aortic valve and the ascending aorta to its mid-portion prior to aortic valve and aortic surgery were examined. The sinuses of Valsalva and proximal ascending aorta were measured from 2-dimensional co-planar echocardiographic images. We observed strong associations between patient habitus and raw and normalized dimensions of the aortic root and ascending aorta. Patients with R-L morphotype presented at an older age with larger aortic root but similar ascending aortic dimensions. After accounting for patient morphometric characteristics and severity of aortic valve disease, patients with R-L valve morphotype were marginally more likely to have an aortic root aneurysm (86% vs. 78%; P = 0.043), defined as aortic root dimension Z score ≥3. We observed only small differences in aortic dimensions between BAV morphotypes, that are eclipsed by variation in patient habitus. We interpret these findings to mean that BAV patients will not likely benefit from therapies based on aortic valve morphotype. Rather, we propose that all BAV patients should undergo longitudinal follow-up, independent of valve morphotype. Guidelines for aortic surgery based upon dimensions alone may be improved by considering patient characteristics such as age, body size and other characteristics.
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.
authors.forename: Karam M
authors.initials: KM
authors.lastname: Habchi
authors.affiliation: Department of Anesthesiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
authors.forename: Elena
authors.initials: E
authors.lastname: Ashikhmina
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.
authors.forename: Vanessa Montiero
authors.initials: VM
authors.lastname: Vieira
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.
authors.forename: Jasmin T
authors.initials: JT
authors.lastname: Shahram
authors.affiliation: Department of Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02115, USA.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Isselbacher
authors.affiliation: Department of Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02115, USA.
authors.forename: Thoralf M
authors.initials: TM
authors.lastname: Sundt
authors.affiliation: Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.
authors.forename: Prem
authors.initials: P
authors.lastname: Shekar
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.
authors.forename: Jochen D
authors.initials: JD
authors.lastname: Muehlschlegel
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA. sbody@partners.org.
authors.forename: Simon C
authors.identifier: http://orcid.org/0000-0001-6721-7050
authors.initials: SC
authors.lastname: Body
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000209:etiology*; D001021:Aortic Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D000082882:Bicuspid Aortic Valve Disease; D049628:Body Size; D004108:Dilatation, Pathologic; D004452:Echocardiography; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012850:Sinus of Valsalva / Q000000981:diagnostic imaging; D055815:Young Adult
keywords: Aortic aneurysm; Aortic valve/*abnormalities/surgery; Ascending aorta; Bicuspid aortic valve; Prognosis