"Nature vs. Nurture" in Bicuspid Aortic Valve Aortopathy: More Evidence that Altered Hemodynamics May Play a Role
There is no disease more conducive to clinical humility than aneurysm of the aorta.1
Bicuspid aortic valve (BAV) is a common congenital cardiac malformation affecting 1 to 2% of the population with a predilection for males.2 While patients with BAV often develop aortic aneurysms requiring surgical intervention,3, 4 the formation of aortic aneurysms is variable and there are currently no good predictors of aneurysm formation. While studies have shown that patients with BAV have genetically inherited aortic disorders that predispose them to aneurysm development,5, 6 there is ongoing controversy concerning the degree to which altered hemodynamics ("nurture") and genetics ("nature") interact. The study of Mahadevia et al in this issue of Circulation7 provides important additional support for the argument that altered flow patterns due to abnormal valve architecture do indeed play a role in BAV aortopathy.
- Received December 2, 2013.
- Accepted December 6, 2013.