Department of Cardiac and Thoracic Surgery, The Chaim Sheba Medical Center, Tel Hashomer 52621, Israel.
Clinics (Sao Paulo). 2010 May;65(5):497-505. doi: 10.1590/S1807-59322010000500007.
A bicuspid aortic valve (BAV) is a common congenital heart disease, which affects 1-2% of the population. However, the relationship between BAVs and aortic dilation has not been sufficiently elucidated.
A total of 241 BAV patients who were referred to this hospital for cardiac surgery over a 4.75-year period were included in this study. In addition to the clinical characteristics of the included patients, the morphological features of the aortic valve and aorta, the length of the left main coronary artery, and the laboratory findings (the coagulation and hematological parameters as well as the total cholesterol concentration) were determined and compared with those of the tricuspid aortic valve (TAV) patients.
The BAV patients were younger than the TAV patients for a valve surgery in the last 3 months of the study period. The BAV patients were predominantly male. Most of the BAVs that were surgically treated were stenotic, regurgitant, or combined, and only 19 (7.88%) were normally functioning valves. According to echocardiography or operative records, 148 (78.31%) were type A, 31 (16.40%) were type B, and 10 (5.29%) were type C. The left main coronary artery was much shorter in the BAV patients than it was in the TAV patients. There was no significant difference between BAV and TAV patients in the total cholesterol concentrations; whereas differences were noted between patients receiving lipid-lowering therapy and those not receiving lipid-lowering therapy. The dimensions of the aortic root, sinotubular junction, and ascending aorta were beyond normal limits, while they were significantly smaller in the BAV patients than in the TAV patients. They were also much smaller in patients receiving statin therapy than those not receiving statin therapy in both groups. Moreover, the aortic dilation in the BAV group was found to be significantly associated with patient age.
The BAV patients developed aortic wall and aortic valve disorders at a younger age than the TAV patients and were predominantly male. Aortic dilation was observed in the aortic root, sinotubular junction, and ascending aortic segments in both the BAV and TAV patients undergoing surgical aortic valve replacement, although the BAV patients had a smaller degree of dilation than the TAV patients, and dilation was also significantly age-related in this group. The shorter left main coronary artery that the BAV patients possess may contribute to the progressive course of aortic dilation that these patients experience. Statin therapy did not affect the aortic annulus in either group, but did decrease the dimensions of the aortic root, sinotubular junction and ascending aorta. In general, statin therapy had a better effect on the aortas of the TAV patients than it did on those of the BAV patients.
二叶式主动脉瓣（BAV）是一种常见的先天性心脏病，影响 1-2%的人群。然而，BAV 与主动脉扩张之间的关系尚未得到充分阐明。
本研究纳入了在过去 4.75 年期间因心脏手术而被转诊至我院的 241 例 BAV 患者。除了包括患者的临床特征外，还确定并比较了主动脉瓣和主动脉的形态特征、左主干冠状动脉的长度以及实验室检查结果（凝血和血液学参数以及总胆固醇浓度）与三叶式主动脉瓣（TAV）患者。
在研究期间最后 3 个月进行瓣膜手术的 BAV 患者比 TAV 患者年轻。BAV 患者主要为男性。大多数接受手术治疗的 BAV 为狭窄、反流或混合性，仅有 19 例（7.88%）为正常功能瓣膜。根据超声心动图或手术记录，148 例（78.31%）为 A 型，31 例（16.40%）为 B 型，10 例（5.29%）为 C 型。BAV 患者的左主干冠状动脉明显短于 TAV 患者。BAV 患者和 TAV 患者的总胆固醇浓度无显著差异；然而，正在接受降脂治疗和未接受降脂治疗的患者之间存在差异。主动脉根部、窦管交界和升主动脉的尺寸超出正常范围，BAV 患者的这些部位明显小于 TAV 患者。两组中接受他汀类药物治疗的患者的这些部位也明显小于未接受他汀类药物治疗的患者。此外，BAV 组的主动脉扩张与患者年龄显著相关。
与 TAV 患者相比，BAV 患者的主动脉壁和主动脉瓣病变发生在更年轻的年龄，且主要为男性。在接受主动脉瓣置换术的 BAV 和 TAV 患者中，均观察到主动脉根部、窦管交界和升主动脉节段的主动脉扩张，尽管 BAV 患者的扩张程度小于 TAV 患者，但在该组中，扩张也与年龄显著相关。BAV 患者较短的左主干冠状动脉可能导致其主动脉扩张的进行性进展。他汀类药物治疗对两组的主动脉瓣环均无影响，但可减小主动脉根部、窦管交界和升主动脉的尺寸。一般来说，他汀类药物治疗对 TAV 患者的主动脉的作用优于 BAV 患者。
