Matthias Bechtel J F, Noack Frank, Sayk Friedhelm, Erasmi Armin W, Bartels Claus, Sievers Hans-Hinrich
Department of Cardiac Surgery, University Hospital Lübeck, Lübeck, Germany.
J Heart Valve Dis. 2003 Jan;12(1):54-9; discussion 59-61.
Bicuspid aortic valve (BAV) is a common inherited condition that is often accompanied by ascending aortic aneurysm. A high level of histological wall abnormalities was reported to be present in non-dilated aortas of patients with BAV. In patients with tricuspid aortic valve, there appears to exist a direct relationship between the diameter of the ascending aorta and degree of histopathological aortic wall abnormalities. Whether this situation exists in patients with BAV has not yet been investigated.
Surgical and medical records of all patients undergoing surgery of the ascending aorta were reviewed. A total of 65 patients was identified in whom an aortic wall specimen was obtained intraoperatively. These specimens were systematically re-evaluated, and graded according to the severity of seven histopathological conditions: fibrosis, atherosclerosis, medionecrosis, cystic medial necrosis, smooth muscle cell orientation, elastic fiber fragmentation, and inflammation.
BAVs were present in 26 patients (40%). Patients with BAV had significantly less aortic wall alterations than patients with tricuspid aortic valves (p < 0.001) in all variables examined. The severity of aortic wall abnormalities was significantly dependent on aortic diameter in patients with BAV as well as tricuspid aortic valve (p = 0.036 and 0.019), but dependent on age (p = 0.009) only in patients with tricuspid aortic valve.
The study results provide evidence that ascending aortic aneurysm in patients with BAV differs clinically and histologically from that in patients with tricuspid aortic valve. Further studies are needed to elucidate the impact of inherited and acquired aortic wall abnormalities on the development of aneurysms.
二叶式主动脉瓣（BAV）是一种常见的遗传性疾病，常伴有升主动脉瘤。据报道，BAV患者未扩张的主动脉存在高度的组织学壁异常。在三尖瓣主动脉瓣患者中，升主动脉直径与组织病理学主动脉壁异常程度之间似乎存在直接关系。BAV患者是否存在这种情况尚未得到研究。
回顾了所有接受升主动脉手术患者的手术和医疗记录。共确定了65例术中获取主动脉壁标本的患者。对这些标本进行系统重新评估，并根据七种组织病理学情况的严重程度进行分级：纤维化、动脉粥样硬化、中层坏死、囊性中层坏死、平滑肌细胞取向、弹性纤维断裂和炎症。
26例患者（40%）存在BAV。在所有检查变量中，BAV患者的主动脉壁改变明显少于三尖瓣主动脉瓣患者（p < 0.001）。BAV患者以及三尖瓣主动脉瓣患者的主动脉壁异常严重程度均显著依赖于主动脉直径（p = 0.036和0.019），但仅在三尖瓣主动脉瓣患者中依赖于年龄（p = 0.009）。
研究结果提供了证据，表明BAV患者的升主动脉瘤在临床和组织学上与三尖瓣主动脉瓣患者不同。需要进一步研究以阐明遗传性和后天性主动脉壁异常对动脉瘤发展的影响。
