Debl Kurt, Djavidani Behrus, Buchner Stefan, Poschenrieder Florian, Schmid Franz-Xaver, Kobuch Reinhard, Feuerbach Stefan, Riegger Günter, Luchner Andreas
Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, F.J.-Strauss-Allee 11, 93042 Regensburg, Germany.
Clin Res Cardiol. 2009 Feb;98(2):114-20. doi: 10.1007/s00392-008-0731-0. Epub 2008 Dec 12.
Bicuspid aortic valve disease (BAV) is increasingly recognized as a disease of the entire proximal aorta including both valvular and vascular complications. The aim of our study was to assess the dimensions of the thoracic aorta using MRI in a broad spectrum of BAV and tricuspid aortic valve disease (TAV) and to define the prevalence of the dilatation of the ascending aorta (AA) >or= 4.5 cm in severe BAV disease.
MRI studies were performed on a 1.5 T scanner in a total of 195 consecutive patients with aortic valve disease. Eighty-four aortic valves were classified as BAV and 103 as TAV. In 8 patients, classification of the aortic valve was not possible due to poor image quality. Mean diameters of the AA were significantly greater in BAV compared to TAV (4.39+/-0.85 Vs. 3.55+/-0.47 cm, P<0.0001), whereas no differences were observed in the mean diameters of the aortic arch. Diameters of the descending aorta were slightly smaller in BAV compared to TAV (2.45+/-0.43 Vs. 2.58+/-0.31 cm, P<0.05). In BAV, AA dilatation was independent of the severity of valve dysfunction. In TAV, aortic regurgitation but not stenosis correlated weakly with AA dilatation. Prevalence of AA dilatation >or= 4.5 cm in BAV with severe aortic stenosis and regurgitation was 38% and 41%, respectively.
Dilatation of the proximal aorta is a frequent finding in BAV and independent of the severity of valve dysfunction. With respect to the high prevalence of AA dilatation >or= 4.5 cm in BAV with severe valve dysfunction, careful assessment of the dimensions of the AA is crucial to identify patients in whom concomitant AA replacement is indicated according to current guidelines.
二叶式主动脉瓣疾病（BAV）越来越被认为是一种累及整个主动脉近端的疾病，包括瓣膜和血管并发症。我们研究的目的是使用磁共振成像（MRI）评估广泛的BAV和三叶式主动脉瓣疾病（TAV）患者的胸主动脉尺寸，并确定严重BAV疾病中升主动脉（AA）直径≥4.5 cm的扩张发生率。
在一台1.5 T扫描仪上对总共195例连续的主动脉瓣疾病患者进行了MRI研究。84个主动脉瓣被分类为BAV，103个为TAV。8例患者因图像质量差无法对主动脉瓣进行分类。与TAV相比，BAV患者的AA平均直径显著更大（4.39±0.85对3.55±0.47 cm，P<0.0001），而主动脉弓的平均直径未观察到差异。与TAV相比，BAV患者降主动脉直径略小（2.45±0.43对2.58±0.31 cm，P<0.05）。在BAV中，AA扩张与瓣膜功能障碍的严重程度无关。在TAV中，主动脉反流而非狭窄与AA扩张的相关性较弱。严重主动脉狭窄和反流的BAV患者中，AA扩张≥4.5 cm的发生率分别为38%和41%。
主动脉近端扩张在BAV中很常见，且与瓣膜功能障碍的严重程度无关。鉴于严重瓣膜功能障碍的BAV患者中AA扩张≥4.5 cm的发生率较高，根据当前指南，仔细评估AA尺寸对于识别需要同时进行AA置换的患者至关重要。
