Division of Cardiovascular Diseases, Mayo Clinic, , Rochester, Minnesota, USA.
Heart. 2013 Nov;99(22):1668-74. doi: 10.1136/heartjnl-2013-304606. Epub 2013 Sep 4.
Bicuspid aortic valve (BAV) is associated with a higher risk of type A aortic dissection (AD) compared with tricuspid aortic valve (TAV). We sought to study differences between patients with BAV and TAV with AD.
Observational descriptive analysis of clinical, imaging and pathological characteristics of all patients with confirmed BAV and AD from 1980-2010, compared with a consecutive TAV group with AD.
Of 47 patients with BAV (mean age 58 ± 14, 77% male), 31 (66%) had acute AD, 16 (34%) had chronic AD, 40 (85%) had typical BAV, 32 (68%) had hypertension and 11 (23%) had previous aortic coarctation repair. Of 53 patients with TAV (mean age 66 ± 13 (p=0.007), 76% male), 34 (66%) had acute AD (p=1.0) and 46 (87%) had hypertension (p=0.03). More patients with BAV had known aortic dilatation prior to AD (49% versus 17%, p=0.001). Presentation symptoms were identical between groups (p=NS). Maximal ascending aortic diameter at AD was higher in patients with BAV (66 ± 15 mm vs 56 ± 11 mm, p=0.0004). Previous aortic valve replacement (AVR) was more common in BAV (23% vs 6%, p=0.02). Of 11 patients with BAV with previous isolated AVR, 7 had ≥ moderate ascending aorta dilatation at the time of surgery. Patients with BAV had increased aortic jet velocity (28% vs 10%) and more severe aortic stenosis (19% vs 0%) at presentation (p=0.04 and 0.002, respectively). In acute AD, aortic medial degeneration affected 75% of BAV specimens and 41% TAV specimens (p=0.01) while aortic atherosclerosis was more frequent in TAV (56% vs 26%, p=0.02).
Compared with patients with TAV, patients with BAV with type A AD are younger, have less hypertension, more valve stenosis and previous AVR, higher maximal aortic dimension, worse aortic medial degeneration, high prevalence of aortic coarctation, and 1 out of 2 have known aortic dilatation prior to AD. Implementation of current guidelines could have theoretically prevented AD in several patients with BAV.
与三尖瓣主动脉瓣（TAV）相比，二叶式主动脉瓣（BAV）与A型主动脉夹层（AD）的风险更高。我们旨在研究 BAV 与 TAV 合并 AD 的患者之间的差异。
对 1980 年至 2010 年间所有确诊为 BAV 合并 AD 的患者的临床、影像学和病理学特征进行观察性描述性分析，并与连续的 TAV 合并 AD 患者组进行比较。
在 47 例 BAV 患者（平均年龄 58±14 岁，77%为男性）中，31 例（66%）为急性 AD，16 例（34%）为慢性 AD，40 例（85%）为典型 BAV，32 例（68%）有高血压，11 例（23%）有既往主动脉缩窄修复史。在 53 例 TAV 患者中（平均年龄 66±13 岁（p=0.007），76%为男性），34 例（66%）为急性 AD（p=1.0），46 例（87%）有高血压（p=0.03）。更多的 BAV 患者在 AD 之前已知主动脉扩张（49%比 17%，p=0.001）。两组患者的首发症状相同（p=NS）。BAV 患者 AD 时升主动脉最大直径更高（66±15mm 比 56±11mm，p=0.0004）。BAV 患者中更常见既往主动脉瓣置换术（AVR）（23%比 6%，p=0.02）。在 11 例既往单独行 AVR 的 BAV 患者中，7 例在手术时存在≥中度升主动脉扩张。BAV 患者在就诊时具有更高的主动脉射流速度（28%比 10%）和更严重的主动脉瓣狭窄（19%比 0%）（p=0.04 和 0.002）。在急性 AD 中，75%的 BAV 标本和 41%的 TAV 标本出现主动脉中层退行性变（p=0.01），而 TAV 中主动脉粥样硬化更为常见（56%比 26%，p=0.02）。
与 TAV 患者相比，合并 A 型 AD 的 BAV 患者更年轻，高血压发生率更低，主动脉瓣狭窄和既往 AVR 更多，最大主动脉直径更大，主动脉中层退行性变更严重，主动脉缩窄的患病率更高，每 2 例患者中就有 1 例在 AD 之前已知主动脉扩张。理论上，实施当前指南可以预防 BAV 患者中的几例 AD。
