Department of Medicine, Division of Cardiovascular Diseases, University of Massachusetts Medical Center, Worcester, MA, USA.
Department of Medicine, Division of Cardiology, University of Rochester Medical Center, Rochester, NY, USA.
Echocardiography. 2021 Mar;38(3):394-401. doi: 10.1111/echo.15000. Epub 2021 Feb 14.
Complications of bicuspid aortic valve commonly include aortic stenosis, aortic regurgitation, and ascending aortic dilation. The progression of these lesions is not well described.
We reviewed 249 bicuspid aortic valve patients with at least two echocardiograms from 2006 to 2016. Valve morphology (right-left or right-noncoronary cusp fusion) was confirmed by visual inspection, and aortic stenosis and regurgitation were quantified according to current guidelines; the ascending aorta was measured at end-systole 2-3 cm above the sinotubular junction. Annualized progression of stenosis, regurgitation, and aortic dilation from first to most recent echocardiogram were compared between right-left and right-nonfused valves using multivariable logistic regression to adjust for baseline differences in groups.
Among 249 bicuspid aortic valve patients (mean age 47.6 ± 13.5 years, 66.3% male), 75.9% had right-left cusp fusion. At baseline, aortic stenosis was absent or mild in 80.3%; aortic regurgitation was absent or mild in 80.7%; and aortic diameters were 35.0 ± 5.7 mm (sinuses of Valsalva) and 37.4 ± 6.2 mm (ascending). Mean annualized decrease in aortic valve area was 0.07 cm /year, with 30% of bicuspid aortic valve patients progressing ≥0.1 cm /year. Aortic regurgitation progressed ≥1 grade in 37 patients. Mean annualized increase in ascending aorta diameter was 0.36 mm/year in right-left and 0.65 mm/year in right-nonbicuspid valves.
In this serial echocardiographic study of bicuspid aortic valve patients, cusp orientation was not associated with progression of valve dysfunction. Right-noncoronary cusp fusion was associated with ascending aortic diameter progression.
二叶式主动脉瓣的并发症通常包括主动脉瓣狭窄、主动脉瓣反流和升主动脉扩张。这些病变的进展情况尚不清楚。
我们回顾了 2006 年至 2016 年期间至少有两次超声心动图检查的 249 例二叶式主动脉瓣患者。通过视觉检查确认瓣叶形态（右-左或右-无冠状动脉瓣叶融合），根据现行指南量化主动脉瓣狭窄和反流；在窦管交界处上方 2-3cm 的收缩期末测量升主动脉。使用多变量逻辑回归比较左-右和右-非融合瓣叶在首次和最近一次超声心动图之间狭窄、反流和升主动脉扩张的年进展率，以调整组间基线差异。
在 249 例二叶式主动脉瓣患者（平均年龄 47.6±13.5 岁，66.3%为男性）中，75.9%有右-左瓣叶融合。基线时，主动脉瓣狭窄为无或轻度 80.3%；主动脉瓣反流为无或轻度 80.7%；主动脉直径为 35.0±5.7mm（瓦尔萨尔瓦窦）和 37.4±6.2mm（升主动脉）。主动脉瓣面积的平均年下降率为 0.07cm /年，30%的二叶式主动脉瓣患者进展≥0.1cm /年。37 例患者的主动脉瓣反流进展≥1 级。右-左瓣叶的升主动脉直径平均每年增加 0.36mm，右-非瓣叶的升主动脉直径平均每年增加 0.65mm。
在这项二叶式主动脉瓣患者的连续超声心动图研究中，瓣叶取向与瓣膜功能障碍的进展无关。无冠状动脉瓣叶融合与升主动脉直径的进展有关。
