Morgan-Hughes Gareth J, Roobottom Carl A, Owens Patrick E, Marshall Andrew J
Department of Cardiology, South West Cardiothoracic Centre, Plymouth NHS Trust, Plymouth, United Kingdom.
Am Heart J. 2004 Apr;147(4):736-40. doi: 10.1016/j.ahj.2003.10.044.
Aortic complications are more frequent after bicuspid aortic valve (BAV) replacement (AVR), than tricuspid aortic valve replacement. We studied the size of the proximal thoracic aorta in patients with BAV undergoing AVR for pure, severe aortic stenosis, looking for dilatation in comparison with patients with a matched tricuspid aortic valve (TAV) and normograms of aortic size.
Aortic root and ascending aortic diameter measurements were taken at 3 levels, from electrocardiographic-gated multidetector row computed tomograms, in 28 patients with pure, severe aortic stenosis before AVR. The patients were divided in 2 groups (BAV, n = 10; TAV, n = 18). Patients with greater than mild aortic regurgitation or who were scheduled for aortic root replacement were excluded.
Although patients in the BAV group were younger (P <.0001) and less likely to have hypertension (P <.005), their aortic diameters were larger than those of patients in the TAV group at all levels measured (aortic sinus, 41.1 +/- 8.1 mm vs 33.8 +/- 3.3 mm; sino-tubular junction, 39.0 +/- 7.8 mm vs 31.1 +/- 3.8 mm; right pulmonary artery level, 42.8 +/- 7.1 mm vs 33.7 +/- 4.3 mm; P <.005 for all). Whereas 60% (6/10) of patients in the BAV group had >/=1 aortic diameter measurements greater than the 95th age-adjusted percentile, 0% (0/18) of patients in the TAV group did.
Patients with BAV undergoing AVR with pure, severe aortic stenosis commonly have moderate dilatation of the thoracic aorta, whereas matched patients with a TAV do not. This finding may contribute to the increased frequency of aortic complications seen in follow up of patients with a BAV after AVR.
与三尖瓣主动脉瓣置换术相比，二叶式主动脉瓣（BAV）置换术（AVR）后主动脉并发症更为常见。我们研究了因单纯严重主动脉瓣狭窄接受AVR的BAV患者的胸主动脉近端大小，与匹配的三尖瓣主动脉瓣（TAV）患者及主动脉大小正常参考值进行比较，以寻找扩张情况。
在28例AVR术前单纯严重主动脉瓣狭窄患者中，通过心电图门控多层螺旋CT在3个层面测量主动脉根部和升主动脉直径。患者分为2组（BAV组，n = 10；TAV组，n = 18）。排除主动脉瓣反流大于轻度或计划进行主动脉根部置换的患者。
尽管BAV组患者更年轻（P <.0001）且患高血压的可能性更小（P <.005），但在所有测量层面，其主动脉直径均大于TAV组患者（主动脉窦，41.1±8.1 mm对33.8±3.3 mm；窦管交界，39.0±7.8 mm对31.1±3.8 mm；右肺动脉水平，42.8±7.1 mm对33.7±4.3 mm；所有P <.005）。BAV组60%（6/10）的患者至少有1次主动脉直径测量值大于年龄校正后的第95百分位数，而TAV组患者中这一比例为0%（0/18）。
因单纯严重主动脉瓣狭窄接受AVR的BAV患者胸主动脉通常有中度扩张，而匹配的TAV患者则无。这一发现可能有助于解释BAV患者AVR术后随访中主动脉并发症发生率增加的原因。
