Philip Femi, Faza Nadine Nadar, Schoenhagen Paul, Desai Milind Y, Tuzcu E Murat, Svensson Lars G, Kapadia Samir R
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Catheter Cardiovasc Interv. 2015 Aug;86(2):E88-98. doi: 10.1002/ccd.25948. Epub 2015 Apr 24.
Patients with severe aortic stenosis due to BAV are excluded from transcatheter aortic valve replacement (TAVR) due to concern for asymmetric expansion and valve dysfunction. We sought to characterize the aortic root and annulus in bicuspid aortic valve (BAV) and tricuspid aortic valves (TAV).
We identified patients with severe AS who underwent multi-detector computed tomographic (MDCT) imaging prior to surgical aortic valve replacement (SAVR, n = 200) for BAV and TAVR (n = 200) for TAV from 2010 to 2013. The presence of a BAV was confirmed on surgical and pathological review. Annulus measurements of the basal ring (short- and long-axis, area-derived diameter), coronary ostia height, sinus area (SA), sino-tubular junction area (STJ), calcification and eccentricity index (EI, 1-short axis/long axis) were made. Patients with TAV were older (78.8 years vs. 57.8 years, P = 0.04) than those with BAV. The aortic annulus area (5.21 ± 2.1 cm(2) vs. 4.63 ± 2.0 cm(2) , P = 0.0001), sinus of Valsalva diameter (3.7 ± 0.9 cm vs. 3.1 ± 0.1 cm, P = 0.001) and ascending aorta diameter (3.5 ± 0.7 cm vs. 2.97 ± 0.6 cm, P = 0.001) were significantly larger with BAV. Bicuspid aortic annuli were significantly less elliptical (EI, 1.24 ± 0.1 vs. 1.29 ± 0.1, P = 0.006) and more circular (39% vs. 4%, P < 0.001) compared to the TAV annulus. There was more eccentric annular calcification in BAV vs. TAV (68% vs. 32%, P < 0.001). The mean distance from the aortic annulus to the left main coronary ostium was less than the right coronary ostium. Less than 10% of the BAV annuli would not fit a currently available valved stents.
Bicuspid aortic valves have a larger annulus size, sinus of Valsalva and ascending aorta dimensions. In addition, the BAV aortic annuli appear circular and most will fit currently available commercial valved stents.
由于担心不对称扩张和瓣膜功能障碍，患有二叶式主动脉瓣（BAV）导致的严重主动脉瓣狭窄的患者被排除在经导管主动脉瓣置换术（TAVR）之外。我们试图描述二叶式主动脉瓣（BAV）和三叶式主动脉瓣（TAV）的主动脉根部和瓣环特征。
我们确定了2010年至2013年间因BAV接受外科主动脉瓣置换术（SAVR，n = 200）和因TAV接受TAVR（n = 200）的严重主动脉瓣狭窄患者。通过手术和病理检查确认BAV的存在。测量瓣环基环（短轴和长轴、面积衍生直径）、冠状动脉开口高度、窦面积（SA）、窦管交界面积（STJ）、钙化和偏心指数（EI，1 - 短轴/长轴）。TAV患者比BAV患者年龄更大（78.8岁对57.8岁，P = 0.04）。BAV的主动脉瓣环面积（5.21±2.1 cm²对4.63±2.0 cm²，P = 0.0001）、主动脉窦直径（3.7±0.9 cm对3.1±0.1 cm，P = 0.001）和升主动脉直径（3.5±0.7 cm对2.97±0.6 cm，P = 0.001）显著更大。与TAV瓣环相比，二叶式主动脉瓣环的椭圆度明显更小（EI，1.24±0.1对1.29±0.1，P = 0.006）且更接近圆形（39%对4%，P < 0.001）。与TAV相比，BAV的瓣环钙化更偏心（68%对32%，P < 0.001）。从主动脉瓣环到左主冠状动脉开口的平均距离小于到右冠状动脉开口的距离。不到10%的BAV瓣环不适合目前可用的带瓣支架。
二叶式主动脉瓣的瓣环尺寸、主动脉窦和升主动脉尺寸更大。此外，BAV的主动脉瓣环呈圆形，大多数适合目前可用的商用带瓣支架。
