Menzies Institute for Medical Research, University of Tasmania, Hobart, Tas, Australia; Department of Cardiothoracic Surgery, Royal Hobart Hospital, Hobart, Tas, Australia.
Department of Radiology, Royal Hobart Hospital, Hobart, Tas, Australia.
Heart Lung Circ. 2021 Jul;30(7):1058-1066. doi: 10.1016/j.hlc.2020.12.004. Epub 2021 Jan 22.
Bicuspid aortic valves (BAV) and related aortopathy remain an intriguing topic. Not all BAVs get diseased and around 40% would develop aortic dilatation in their lifetime. If haemodynamic theory is to be believed, then leaflet fusion pattern should have an impact. This study sought to compare the association of aortic morphologies and rate of growth in a set of 102 BAV acropathies operated at a single centre, based on the fusion patterns.
Data on aortic valve replacements over a 10-year period was analysed from a prospectively maintained database. Of the 198 BAV undergoing surgery, 102 had aortic dilatation above 40 mm on echocardiogram. These underwent computed tomography (CT) aortograms and were followed up as a part of a database. The impact of leaflet fusion patterns on aortic dilatation pattern and rate was analysed.
Of the 102, two patients had type 0 pathology and one had left-noncoronary (LN) leaflet fusion. Seventy-four (74) had type 1A or left-right (RL) fusion and 25 had type 1B right-noncoronary (RN) fusion. RL fusion had more males, were taller, bigger and had more proportion of aortic stenosis (AS). Aortic diameters, angles and growth rates at root, ascending/descending aorta and arch were not different. Regression analyses for size or growth did not show any significant impact of fusion pattern.
Left-right fusion pattern comprised three-quarters of BAV in this cohort and these patients were bigger, taller and had a greater proportion of males with increased rate of aortic stenosis. Despite these differences, there was no significant impact of fusion pattern on aortic size or rate of growth.
二叶式主动脉瓣（BAV）和相关的主动脉瓣病变仍然是一个有趣的话题。并非所有的 BAV 都会患病，大约 40%的患者在其一生中会发展为主动脉扩张。如果血流动力学理论成立，那么瓣叶融合模式应该会有影响。本研究旨在根据融合模式，比较一组 102 例在单一中心接受手术的 BAV 瓣叶融合异常患者的主动脉形态和生长速度的相关性。
从一个前瞻性维护的数据库中分析了 10 年间进行的主动脉瓣置换术的数据。在 198 例接受手术的 BAV 中，有 102 例超声心动图显示主动脉扩张超过 40mm。这些患者接受了计算机断层扫描（CT）主动脉造影，并作为数据库的一部分进行了随访。分析了瓣叶融合模式对主动脉扩张模式和速度的影响。
在 102 例患者中，有 2 例患者为 0 型病变，1 例为左非冠状动脉（LN）瓣叶融合。74 例为 1A 型或左右（RL）融合，25 例为 1B 型右非冠状动脉（RN）融合。RL 融合组的男性更多，身材更高大，主动脉瓣狭窄（AS）的比例更高。根部、升主动脉/降主动脉和弓部的主动脉直径、角度和生长速率没有差异。大小或生长的回归分析没有显示融合模式有任何显著影响。
在本队列中，左右融合模式占 BAV 的四分之三，这些患者更大、更高大，男性比例更高，主动脉瓣狭窄的发生率更高。尽管存在这些差异，但融合模式对主动脉大小或生长速度没有显著影响。
