This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Yasuda, H. Articles by Miyatake, K. Search for Related Content PubMed PubMed Citation Articles by Yasuda, H. Articles by Miyatake, K.

(Circulation. 2003;108:II-291.)
© 2003 American Heart Association, Inc.

Surgery for Aortic and Peripheral Vascular Disease

Failure to Prevent Progressive Dilation of Ascending Aorta by Aortic Valve Replacement in Patients With Bicuspid Aortic Valve: Comparison With Tricuspid Aortic Valve

Hisayo Yasuda, MD; Satoshi Nakatani, MD, PhD; Marie Stugaard, MD, PhD; Yuko Tsujita-Kuroda, MD, PhD; Ko Bando, MD, PhD; Junjiro Kobayashi, MD, PhD; Masakazu Yamagishi, MD, PhD; Masafumi Kitakaze, MD, PhD; Soichiro Kitamura, MD, PhD; Kunio Miyatake, MD, PhD

From the Departments of Cardiology and Cardiothoracic Surgery, National Cardiovascular Center, Osaka, Japan.

Correspondence to Satoshi Nakatani, MD, PhD, Department of Cardiology, National Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan. Phone: 81-6-6833-5012; Fax: 81-6-6872-7486; E-mail: nakatas{at}hsp.ncvc.go.jp

Background— Patients with bicuspid aortic valve (BAV) have been frequently complicated with ascending aortic dilation possibly because of hemodynamic burdens by aortic stenosis (AS) or regurgitation (AR) or congenital fragility of the aortic wall.

Methods and Results— To clarify if the aortic dilation could be prevented by aortic valve replacement (AVR) in BAV patients, we studied 13 BAV (8 AR dominant, 5 AS dominant) and 14 tricuspid aortic valve (TAV) patients (7 AR, 7 AS) by echocardiography before and after AVR (9.7±4.8 years). We also studied 18 BAV (11 AR, 7 AS) without AVR. Diameters of the sinuses of Valsalva, sinotubular junction and the proximal aorta were measured. The annual dilation rate was calculated by dividing changes of diameters during the follow-up period by the body surface area and the observation interval. We found that aortic dilation in BAV patients tended to be faster than that in TAV patients, although a significant difference was found only at the proximal aorta (0.18±0.08 versus -0.08±0.08 mm/(m²/year), P=0.03). BAV patients with and without AVR showed similar progressive dilation. AR dominant group showed tendency of more progressive dilation than AS dominant group in BAV, although it did not reach statistical significance. TAV patients did not show further aortic dilation after AVR.

Conclusions— AVR could not prevent progressive aortic dilation in BAV. Since the aorta did not dilate in TAV, progressive aortic dilation in BAV seems mainly due to the fragility of the aortic wall rather than hemodynamic factors.

Key Words: aortic valve • heart valve prosthesis • aneurysms