Borović Saša D, Labudović Borović Milica M, Zaletel Ivan V, Todorović Vera N, Dabić Petar A, Rakočević Jelena T, Marinković-Erić Jelena M, Milojević Predrag S
Dedinje Cardiovascular Institute, Belgrade, Serbia, 1 Heroja Milana Tepića Street, Belgrade, 11000, Serbia.
Institute of Histology and Embryology "Aleksandar Đ. Kostić", Faculty of Medicine, University of Belgrade, 26 Višegradska Street, Belgrade, 11000, Serbia.
J Cardiothorac Surg. 2018 Jan 18;13(1):12. doi: 10.1186/s13019-017-0671-8.
Histopathological changes in the ascending aorta wall in patients with severe tricuspid aortic valve (TAV) stenosis were graded and correlated to echocardiographic parameters. Objective was to associate threshold echocardiographic values with structural defects in the ascending aorta providing a tool to improve decision-making process in cases when simultaneous aortic valve replacement (AVR) and ascending aorta replacement is considered.
Biopsies from 108 TAV stenosis patients subjected to AVR were graded into three grades according to severity of aortic wall changes. Echocardiographic parameters obtained preoperatively and correlated to grade, age, gender and risk factors, were diameters of ventriculo-aortic junction (AA), sinus Valsalva (SV), sinotubular junction (STJ), the largest diameter of the visualized ascending aorta (AscA) as well as indexes: sinus Valsalva (SVI), sinotubular junction (STJI), AscA/AA and STJ/AA.
Two echocardiographic parameters portrayed grades with statistical significance: STJ (F = 5.417; p = 0.006 (p < 0.05)) and AscA (F = 3.924; p = 0.023 (p < 0.05)). By using multiple predictors in the setting of Regression analysis, statistically significant differences among grades were reached for AA, SV, STJ, AscA and SVI. With further ROC curves analysis, threshold values for different grades were recognized. Grade 2 is identified in patients with AscA > 3.3 cm, while Grade 3 is identified in patients with values of AscA > 3.5 cm, STJ > 2.9 cm and STJI > 1.
Hemodynamic stress induced by TAV stenosis leads to elastic lamellae disruption in the aortic wall. Those changes could be graded and correlated with echocardiographic parameters of the aortic root and ascending aorta, providing a tool for decision to replace ascending aorta concomitantly with AVR.
对重度三尖瓣主动脉瓣（TAV）狭窄患者升主动脉壁的组织病理学变化进行分级，并与超声心动图参数相关联。目的是将超声心动图阈值与升主动脉的结构缺陷相关联，为在考虑同时进行主动脉瓣置换（AVR）和升主动脉置换的情况下改进决策过程提供一种工具。
对108例行AVR的TAV狭窄患者的活检标本，根据主动脉壁变化的严重程度分为三个等级。术前获得的超声心动图参数与等级、年龄、性别和危险因素相关，包括心室-主动脉交界（AA）、主动脉窦（SV）、窦管交界（STJ）的直径、可见升主动脉（AscA）的最大直径以及指数：主动脉窦（SVI）、窦管交界（STJI）、AscA/AA和STJ/AA。
两个超声心动图参数描绘等级具有统计学意义：STJ（F = 5.417；p = 0.006（p < 0.05））和AscA（F = 3.924；p = 0.023（p < 0.05））。在回归分析中使用多个预测因子时，AA、SV、STJ、AscA和SVI在等级之间达到了统计学显著差异。通过进一步的ROC曲线分析，识别出不同等级的阈值。AscA > 3.3 cm的患者被识别为2级，而AscA > 3.5 cm、STJ > 2.9 cm和STJI > 1 的患者被识别为3级。
TAV狭窄引起的血流动力学应激导致主动脉壁弹性板破裂。这些变化可以分级，并与主动脉根部和升主动脉的超声心动图参数相关联，为决定在AVR的同时置换升主动脉提供了一种工具。
