Hostname: page-component-8448b6f56d-xtgtn Total loading time: 0 Render date: 2024-04-23T22:47:12.940Z Has data issue: false hasContentIssue false
  • English
  • Français

Progressive dilation of the diameter of the aortic root in adults with a bicuspid aortic valve

Published online by Cambridge University Press:  24 May 2005

Annie Dore ,
Marie-Claude Brochu ,
Jean-François Baril ,
Marie-Claude Guertin  and
Lise-Andrée Mercier
Annie Dore
Affiliation:
Research Center, Montreal Heart Institute, Montreal, Quebec, Canada
Marie-Claude Brochu
Affiliation:
Research Center, Montreal Heart Institute, Montreal, Quebec, Canada
Jean-François Baril
Affiliation:
Research Center, Montreal Heart Institute, Montreal, Quebec, Canada
Marie-Claude Guertin
Affiliation:
Research Center, Montreal Heart Institute, Montreal, Quebec, Canada
Lise-Andrée Mercier
Affiliation:
Research Center, Montreal Heart Institute, Montreal, Quebec, Canada
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: To determine the rate of progression of dilation of the aortic root in adults with a bicuspid aortic valve. Methods: We reviewed retrospectively the transthoracic echocardiograms of 50 adults with a bicuspid aortic valve. Each patient had had at least two examinations made 12 months apart. Measurements were taken at four levels: at the basal attachment of the leaflets of the valve within the left ventricular outflow tract, at the widest point of the sinuses of Valsalva, at the sinutubular junction, and in the ascending aorta 1 cm beyond the sinutubular junction. Results: Progressive dilation occurred at all levels, ranging from 0.3 mm/yr at the basal attachment within the left ventricular outflow tract to 1.0 mm/yr, 1 cm beyond sinutubular junction. These rates of dilation were greater than the reported rate of 0.8 mm per decade in the normal population. The rate of dilation found in the ascending aorta 1 cm beyond the sinutubular junction was significantly greater than at the other sites (p = 0.005). The 21 patients with baseline measurements greater than 34 mm had a significantly higher rate of progression (p = 0.007). Sex, age, and the degree of valvar obstruction or regurgitation did not significantly influence the rate of progression of dilation. Conclusion: There is a significantly higher rate of dilation of the aortic root in adults with a bicuspid aortic valve when compared to the normal population. Periodic evaluation of the ascending aorta is essential in these patients, even after replacement of the aortic valve. Other imaging modalities should be considered if the region beyond the sinutubular junction is not well visualized by transthoracic echocardiography.

Keywords

Aortaadult congenital heart diseasegrown-ups with congenital heart disease
Type
Original Article
Information
Cardiology in the Young , Volume 13 , Issue 6 , December 2003 , pp. 526 - 531
Copyright
© 2003 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Roberts WC. The congenitally bicuspid aortic valve: a study of 85 autopsy cases. Am J Cardiol 1970; 26: 72–83.Google Scholar
Fenoglio JJ, McAllister HA, DeCastro CM, Davia JE, Cheitlin MD. Congenital bicuspid aortic valve after age 20. Am J Cardiol 1977; 39: 164–169.Google Scholar
Sabet HY, Edwards WD, Tazelaar HD, Daly RC. Congenitally bicuspid aortic valves: a surgical pathology study of 542 cases (1991 through 1996) and a literature review of 2715 additional cases. Mayo Clin Proc 1999; 74: 14–26.Google Scholar
Brandenburg RO, Tajik AJ, Edwards WD, Reeder GS, Shub C, Seward JB. Accuracy of 2-dimensional echocardiographic diagnosis of congenitally bicuspid aortic valve: echocardiographic–anatomic correlation in 115 patients. Am J Cardiol 1983; 51: 1469–1473.Google Scholar
Roberts CS, Roberts WC. Dissection of the aorta with congenital malformation of the aortic valve. J Am Coll Cardiol 1991; 17: 712–716.Google Scholar
Burks JM, Illes RW, Keating EC, Lubbe WJ. Ascending aortic aneurysm and dissection in young adults with bicuspid aortic valve: implications for echocardiographic surveillance. Clin Cardiol 1998; 21: 439–443.Google Scholar
Larson EW, Edwards WD. Risk factors for aortic dissection: a necropsy study of 161 cases. Am J Cardiol 1984; 53: 849–855.Google Scholar
Hahn RT, Roman MJ, Mogtader AH, Devereux RB. Association of aortic dilation with regurgitant, stenotic and functionally normal bicuspid aortic valves. J Am Coll Cardiol 1992; 19: 283–288.Google Scholar
Keane MG, Wiegers SE, Plappert T, Pochettino A, Bavaria JE, St. John Sutton MG. Bicuspid aortic valves are associated with aortic dilatation out of proportion to coexistent valvular lesions. Circulation 2000; 102 (Suppl III): III35–III39.Google Scholar
Vasan RS, Larson MG, Levy D. Determinants of echocardiographic aortic root size: the Framingham Heart Study. Circulation 1995; 91: 734–740.Google Scholar
Hager A, Kaemmerer H, Rapp-Bernhardt U, et al. Diameters of the thoracic aorta throughout life as measured with helical computed tomography. J Thorac Cardiovasc Surg 2002; 123: 1060–1066.Google Scholar
Roman MJ, Devereux RB, Kramer-Fox R, O'Loughlin J, Spitzer M, Robins J. Two-dimensional echocardiographic aortic root dimensions in normal children and adults. Am J Cardiol 1989; 64: 507–512.Google Scholar
Pachulski RT, Weinberg AL, Chan KL. Aortic aneurysm in patients with functionally normal or minimally stenotic bicuspid aortic valve. Am J Cardiol 1991; 67: 781–782.Google Scholar
Nistri S, Sorbo MD, Marin M, Palisi M, Scognamiglio R, Thiene G. Aortic root dilatation in young men with normally functioning bicuspid aortic valves. Heart 1999; 82: 19–22.Google Scholar
McKusick VA. Association of congenital bicuspid aortic valve and Erdheim's cystic medial necrosis. Lancet 1972; 1: 1026–1027.Google Scholar
de Sa M, Moshkovitz Y, Butany J, David TE. Histologic abnormalities of the ascending aorta and pulmonary trunk in patients with bicuspid aortic valve disease: clinical relevance to the Ross procedure. J Thorac Cardiovasc Surg 1999; 118: 588–596.Google Scholar
Niwa K, Perloff JK, Bhuta SM, et al. Structural abnormalities of great arterial walls in congenital heart disease. Circulation 2001; 103: 393–400.Google Scholar
Fleisher KJ, Nousari HC, Anhalt GJ, Stone CD, Laschinger JC. Immunohistochemical abnormalities in fibrillin in cardiovascular tissues in Marfan's syndrome. Ann Thorac Surg 1997; 63: 1012–1017.Google Scholar
Gott VL, Greene PS, Alejo DE, et al. Replacement of the aortic root in patients with Marfan's syndrome. N Engl J Med 1999; 340: 1307–1313.Google Scholar
Kornbluth M, Schnittger I, Eyngorina I, Gasner C, Liang DH. Clinical outcome in the Marfan Syndrome with ascending aortic dilatation followed annually by echocardiography. Am J Cardiol 1999; 84: 753–755.Google Scholar