Della Corte Alessandro, Romano Gianpaolo, Tizzano Francesco, Amarelli Cristiano, De Santo Luca S, De Feo Marisa, Scardone Michelangelo, Dialetto Giovanni, Covino Franco E, Cotrufo Maurizio
Department of Cardiothoracic Sciences, Second University of Naples, Department of Cardiovascular Surgery and Transplants, Monaldi Hospital, Naples, Italy.
Int J Cardiol. 2006 Nov 18;113(3):320-6. doi: 10.1016/j.ijcard.2005.11.043. Epub 2006 Jan 18.
Different anatomical forms of proximal aortic dilations associated with aortic valve disease can be distinguished by echocardiography. Differences in the anatomy could reflect different pathogeneses and need for different therapeutic approaches. The present study assessed the clinical features associated to each anatomical form, particularly focusing on the relations with valve morphology and function.
Trans-thoracic and trans-esophageal echocardiography reports of 552 adult patients (mean age 60.4+/-12.8 years; 379 male) with mild to severe proximal aorta dilation were reviewed. The relationships between the anatomy of aorta dilatation (distinguished into "root type" dilatation, with maximal enlargement at the sinuses, and "mid-ascending type", with maximal diameter at the mid-ascending tract) and aortic valve morphology (tricuspid/bicuspid) and function (normal/stenosis/regurgitation) were assessed. The relations with other clinico-echocardiographic variables were also tested in univariate and multivariate analysis.
A "root type" dilatation was found in 4.9% tricuspid patients with stenosis, 32.3% with regurgitation, 22.5% with normal valve function (p=0.018). Dilatation prevailed at the mid-ascending tract in patients with bicuspid aortic valve, irrespective of valve function (stenotic: 92.9%, regurgitant: 87.9%, normal: 94.3%; p=0.23). Predominant root involvement was significantly more prevalent in male patients (24.8% versus 5.2% in females; p<0.001). In multivariate analysis, predominant aortic valve regurgitation (OR=1.83; p=0.028) independently predicted root site, while predominant aortic valve stenosis (OR=3.70; p=0.001), bicuspidity (OR=2.90; p=0.005) and female sex (OR=6.10; p<0.001) predicted mid-ascending site.
Pathogenetical considerations arise from the evidence of preferential mid-ascending localization of bicuspid-associated aortic dilatations. This finding is consistent with previous studies on bicuspid valve models revealing a wall stress overload beyond the sino-tubular ridge.
超声心动图可区分与主动脉瓣疾病相关的不同解剖形式的升主动脉近端扩张。解剖结构的差异可能反映不同的发病机制以及对不同治疗方法的需求。本研究评估了与每种解剖形式相关的临床特征，尤其关注与瓣膜形态和功能的关系。
回顾了552例成年患者（平均年龄60.4±12.8岁；男性379例）轻度至重度升主动脉近端扩张的经胸和经食管超声心动图报告。评估主动脉扩张的解剖结构（分为“根部型”扩张，即窦部最大程度扩大，以及“升主动脉中段型”，即升主动脉中段直径最大）与主动脉瓣形态（三尖瓣/二叶瓣）和功能（正常/狭窄/反流）之间的关系。还在单因素和多因素分析中测试了与其他临床超声心动图变量的关系。
在三尖瓣患者中，“根部型”扩张在狭窄患者中占4.9%，反流患者中占32.3%，瓣膜功能正常患者中占22.5%（p = 0.018）。二叶式主动脉瓣患者升主动脉中段扩张为主，与瓣膜功能无关（狭窄：92.9%，反流：87.9%，正常：94.3%；p = 0.23）。男性患者根部受累为主更为常见（24.8%对女性的5.2%；p < 0.001）。在多因素分析中，主要的主动脉瓣反流（OR = 1.83；p = 0.028）独立预测根部位置，而主要的主动脉瓣狭窄（OR = 3.70；p = 0.001）、二叶瓣（OR = 2.90；p = 0.005）和女性（OR = 6.10；p < 0.001）预测升主动脉中段位置。
二叶瓣相关主动脉扩张优先位于升主动脉中段这一证据引发了对发病机制的思考。这一发现与先前关于二叶瓣模型的研究一致，该研究揭示了窦管嵴以外的壁应力过载。
