Relationship between Bicuspid Aortic Valve and Ascending Aortic Dilatation Assessed by Computed Tomography Angiography_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANGQi , LIUHong-hao , YAOXing-xing , JIAOZhou-yang , ZHANGHang ,  LIUChao

Department of Cardiac Surgery, Zhengzhou University, Zhengzhou 450052, P. R. China;

Corresponding author：

LIUChao, Email: Liubeilun@sohu.com

Keywords：

Bicuspid aortic valve; Ascending aortic dilatation; Electrocardiogram-gated computed tomography angiography; Aortic diameters

DOI：

10.7507/1007-4848.20160249

Video：

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Objective To find the relationship between bicuspid aortic valve (BAV) and the dilatation or aneurysm of the aorta using electrocardiogram-gated computed tomography angiography (CTA). Methods We collected the clinical data of the BAV coexisting with suspected aortic dilatation or aneurysm from February 2012 through April 2015. A total of 124 patients were analyzed retrospectively. There were 97 males and 27 females at an anverage age of 50.35±16.26 years. According to the CTA, patients were classified into two groups: a pure BAV(without raphe) group and a BAV (with raphe) group. we recorded the aortic diameters, gender, age, and so on. Results Of the 124 patients, 91 (73.4%) had BAV with raphe, and 33 patients (26.6%) had pure BAV. The analysis revealed that the diameter of the annulus (23.90±3.34 mm vs. 21.74±3.46 mm, P=0.005), the sinuses of Valsalva (40.93±6.78 mm vs. 37.35±7.06 mm, P=0.022), the tubular portion of the ascending aorta (45.38±7.66 mm vs. 38.29±8.18 mm, P=0.0001), and the part of the aorta proximal to the innominate artery (34.19±4.98 mm vs. 30.23±6.62 mm, P=0.02) between patients with BAV with raphe and pure BAV had significant differences. And there was a significant difference in prevalence of dilatation of the aorta between patients with pure BAV and BAV with raphe [77/91 (84.6%) vs.18/31(58.1%), P=0.004]. Of the 91 BAV with raphe patients, we found 76 patients (83.5%) with right and left coronary cusps (R-L) fusion, 13 patients (14.3%) with right and non-coronary cusps (R-N) fusion, and 2 patients (1.2%) with left and non-coronary cusps (L-N) fusion. There was a statistical difference in the aortic root diameters between R-L fusion BAV and R-N fusion BAV. The diameter of the distal ascending aorta and proximal aortic arch between R-L and R-N fusion BAV had statistical differences. Conclusions BAV with raphe is more common than pure BAV and is more often associated with dilatation and aneurysm of the ascending aorta. Otherwise R-L fusion BAV is associated with increased diameters of the aortic root, while R-N fusion BAV is associated with increased diameters of the distal ascending aorta and proximal arch.

Citation： ZHANGQi, LIUHong-hao, YAOXing-xing, JIAOZhou-yang, ZHANGHang, LIUChao. Relationship between Bicuspid Aortic Valve and Ascending Aortic Dilatation Assessed by Computed Tomography Angiography. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(11): 1061-1065. doi: 10.7507/1007-4848.20160249 Copy

1.	Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics-2011 update: a report from the American Heart Associa-tion. Circulation, 2011, 123(4): 18-209.
2.	Siu SC, Silversides CK. Bicuspid aortic valve disease. J Am Coll Cardiol, 2010, 55(25): 2789-2800.
3.	Braverman AC. Aortic involvement in patients with a bicuspid aortic valve. Heart, 2011, 97(6): 506-513.
4.	宫霞, 吴卫华.二叶式主动脉瓣畸形的发病机制及并发症的研究进展.中国临床医学, 2015, 22(1): 111-113.
5.	Schaefer BM, Lewin MB, Stout KK, et al. The bicuspid aortic valve: an integrated phenotypic classification of leaflet morphology and aortic root shape. Heart, 2008, 94(12): 1634-1638.
6.	Michelena HI, Khanna AD, Mahoney D, et al. Incidence of aortic complications in patients with bicuspid aortic valves. JAMA, 2011, 306(10): 1104-1112.
7.	Verma S, Siu SC. Aortic dilatation in patients with bicuspid aortic valve. N Engl J Med, 2014, 370(20): 1920-1929.
8.	罗松, 黄鹏飞, 周长圣, 等.双源CT血管成像在先天性主动脉瓣叶畸形诊断中的应用.实用放射学杂志, 2013, 29(2): 212-214.
9.	Michaowska IM, Kruk M, Kwiatek P, et al. Aortic pathology in patients with bicuspid aortic valve assessed with computed tomogra-phy angiography. J Thorac Imaging, 2014, 29(2): 113-117.
10.	Buchner S, Hü lsmann M, Poschenrieder F, et al. Variable phenotypes of bicuspid aortic valve disease: classification by cardiovascular magnetic resonance. Heart, 2010, 96(15): 1233-1240.
11.	Agarwal PP, Chughtai A, Frederick RK. Multi detector CT of the aortic aneurysms. Radiographics, 2009, 29(2): 537-552.
12.	Nkomo VT, Enriquez-Sarano M, Ammash NM, et al. Bicuspid aortic valve associated with aortic dilatation: a community-based study. Arterioscler Thromb Vasc Biol, 2003, 23(2): 351-356.
13.	赵世华, 陆敏杰, 张岩, 等. MRI在心脏瓣膜病中的诊断价值.中华放射学杂志, 2006, 40(12): 1276-1280.
14.	Hope MD, Hope TA, Meadows AK, et al. Bicuspid aortic valve: four-dimensional MR evaluation of ascending aortic systolic flow patterns. Radiology, 2010, 255(1): 53-61.
15.	Barker AJ, Markl M, Burk J, et al. Bicuspid aortic valve is associated with altered wall shear stress in the ascending aorta. Circ Cardiovasc Imaging, 2012, 5(4): 457-466.
16.	Schaefer BM, Lewin MB, Stout KK, et al. The bicuspid aortic valve: an integrated phenotypic classification of leaflet morphology and aortic root shape. Heart, 2008, 94(12): 1634-1638.
17.	Thanassoulis G, Yip J, Filion K, et al. Retrospective study to identify predictors of the presence and rapid progression of aortic dilatation in patients with bicuspid aortic valves. Nat Clin Pract Cardiovasc Med, 2008, 5(12): 821-828.
18.	Jackson V, Petrini J, Caidahl K, et al. Bicuspid aortic valve leaflet morphology in relation to aortic root morphology: a study of 300 patients undergoing open-heart surgery. Eur J Cardiothorac Surg, 2011, 40(3): 118-124.
19.	Detaint D, Michelena HI, Nkomo VT, et al. Aortic dilatation patterns and rates in adults with bicuspid aortic valves: a compara-tive study with Marfan syndrome and degenerative aortopathy. Heart, 2014, 100(2): 126-134.
20.	Ciotti GR, Vlahos AP, Silverman NH. Morphology and function of the bicuspid aortic valve with and without coarctation of the aorta in the young. Am J Cardiol, 2006, 98(8): 1096-1102.
21.	Luijendijk P, Franken RJ, Vriend JW, et al. Increased risk for ascending aortic dilatation in patients with complex compared to simple aortic coarctation. Int J Cardiol, 2013, 167(3): 827-832.
22.	Folger GM, Stein PD. Bicuspid aortic valve morphology when associated with coarctation of the aorta. Catheter Cardiovasc Diagn, 1984, 10(1): 17-25.
23.	Ciotti GR, Vlahos AP, Silverman NH. Morphology and function of the bicuspid aortic valve with and without coarctation of the aorta in the young. Am J Cardiol, 2006, 98(8): 1096-1102.

1. Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics-2011 update: a report from the American Heart Associa-tion. Circulation, 2011, 123(4): 18-209.
2. Siu SC, Silversides CK. Bicuspid aortic valve disease. J Am Coll Cardiol, 2010, 55(25): 2789-2800.
3. Braverman AC. Aortic involvement in patients with a bicuspid aortic valve. Heart, 2011, 97(6): 506-513.
4. 宫霞, 吴卫华.二叶式主动脉瓣畸形的发病机制及并发症的研究进展.中国临床医学, 2015, 22(1): 111-113.
5. Schaefer BM, Lewin MB, Stout KK, et al. The bicuspid aortic valve: an integrated phenotypic classification of leaflet morphology and aortic root shape. Heart, 2008, 94(12): 1634-1638.
6. Michelena HI, Khanna AD, Mahoney D, et al. Incidence of aortic complications in patients with bicuspid aortic valves. JAMA, 2011, 306(10): 1104-1112.
7. Verma S, Siu SC. Aortic dilatation in patients with bicuspid aortic valve. N Engl J Med, 2014, 370(20): 1920-1929.
8. 罗松, 黄鹏飞, 周长圣, 等.双源CT血管成像在先天性主动脉瓣叶畸形诊断中的应用.实用放射学杂志, 2013, 29(2): 212-214.
9. Michaowska IM, Kruk M, Kwiatek P, et al. Aortic pathology in patients with bicuspid aortic valve assessed with computed tomogra-phy angiography. J Thorac Imaging, 2014, 29(2): 113-117.
10. Buchner S, Hü lsmann M, Poschenrieder F, et al. Variable phenotypes of bicuspid aortic valve disease: classification by cardiovascular magnetic resonance. Heart, 2010, 96(15): 1233-1240.
11. Agarwal PP, Chughtai A, Frederick RK. Multi detector CT of the aortic aneurysms. Radiographics, 2009, 29(2): 537-552.
12. Nkomo VT, Enriquez-Sarano M, Ammash NM, et al. Bicuspid aortic valve associated with aortic dilatation: a community-based study. Arterioscler Thromb Vasc Biol, 2003, 23(2): 351-356.
13. 赵世华, 陆敏杰, 张岩, 等. MRI在心脏瓣膜病中的诊断价值.中华放射学杂志, 2006, 40(12): 1276-1280.
14. Hope MD, Hope TA, Meadows AK, et al. Bicuspid aortic valve: four-dimensional MR evaluation of ascending aortic systolic flow patterns. Radiology, 2010, 255(1): 53-61.
15. Barker AJ, Markl M, Burk J, et al. Bicuspid aortic valve is associated with altered wall shear stress in the ascending aorta. Circ Cardiovasc Imaging, 2012, 5(4): 457-466.
16. Schaefer BM, Lewin MB, Stout KK, et al. The bicuspid aortic valve: an integrated phenotypic classification of leaflet morphology and aortic root shape. Heart, 2008, 94(12): 1634-1638.
17. Thanassoulis G, Yip J, Filion K, et al. Retrospective study to identify predictors of the presence and rapid progression of aortic dilatation in patients with bicuspid aortic valves. Nat Clin Pract Cardiovasc Med, 2008, 5(12): 821-828.
18. Jackson V, Petrini J, Caidahl K, et al. Bicuspid aortic valve leaflet morphology in relation to aortic root morphology: a study of 300 patients undergoing open-heart surgery. Eur J Cardiothorac Surg, 2011, 40(3): 118-124.
19. Detaint D, Michelena HI, Nkomo VT, et al. Aortic dilatation patterns and rates in adults with bicuspid aortic valves: a compara-tive study with Marfan syndrome and degenerative aortopathy. Heart, 2014, 100(2): 126-134.
20. Ciotti GR, Vlahos AP, Silverman NH. Morphology and function of the bicuspid aortic valve with and without coarctation of the aorta in the young. Am J Cardiol, 2006, 98(8): 1096-1102.
21. Luijendijk P, Franken RJ, Vriend JW, et al. Increased risk for ascending aortic dilatation in patients with complex compared to simple aortic coarctation. Int J Cardiol, 2013, 167(3): 827-832.
22. Folger GM, Stein PD. Bicuspid aortic valve morphology when associated with coarctation of the aorta. Catheter Cardiovasc Diagn, 1984, 10(1): 17-25.
23. Ciotti GR, Vlahos AP, Silverman NH. Morphology and function of the bicuspid aortic valve with and without coarctation of the aorta in the young. Am J Cardiol, 2006, 98(8): 1096-1102.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Relationship between Bicuspid Aortic Valve and Ascending Aortic Dilatation Assessed by Computed Tomography Angiography

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