Type A aortic dissection in patients with bicuspid aortic valves: Clinical and pathological comparison with tricuspid aortic valves

Mackram Eleid, Inga Forde, William D. Edwards, Joseph Maleszewski, Rakesh M. Suri, Hartzell V Schaff, Maurice E Sarano, Hector I Michelena

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

Objective Bicuspid aortic valve (BAV) is associated with a higher risk of type A aortic dissection (AD) compared with tricuspid aortic valve (TAV). We sought to study differences between patients with BAV and TAV with AD. Design and setting Observational descriptive analysis of clinical, imaging and pathological characteristics of all patients with confirmed BAV and AD from 1980-2010, compared with a consecutive TAV group with AD. Results Of 47 patients with BAV (mean age 58±14, 77% male), 31 (66%) had acute AD, 16 (34%) had chronic AD, 40 (85%) had typical BAV, 32 (68%) had hypertension and 11 (23%) had previous aortic coarctation repair. Of 53 patients with TAV (mean age 66±13 ( p=0.007), 76% male), 34 (66%) had acute AD (p=1.0) and 46 (87%) had hypertension (p=0.03). More patients with BAV had known aortic dilatation prior to AD (49% versus 17%, p=0.001). Presentation symptoms were identical between groups (p=NS). Maximal ascending aortic diameter at AD was higher in patients with BAV (66±15 mm vs 56±11 mm, p=0.0004). Previous aortic valve replacement (AVR) was more common in BAV (23% vs 6%, p=0.02). Of 11 patients with BAV with previous isolated AVR, 7 had >moderate ascending aorta dilatation at the time of surgery. Patients with BAV had increased aortic jet velocity (28% vs 10%) and more severe aortic stenosis (19% vs 0%) at presentation (p=0.04 and 0.002, respectively). In acute AD, aortic medial degeneration affected 75% of BAV specimens and 41% TAV specimens (p=0.01) while aortic atherosclerosis was more frequent in TAV (56% vs 26%, p=0.02). Conclusions Compared with patients with TAV, patients with BAV with type A AD are younger, have less hypertension, more valve stenosis and previous AVR, higher maximal aortic dimension, worse aortic medial degeneration, high prevalence of aortic coarctation, and 1 out of 2 have known aortic dilatation prior to AD. Implementation of current guidelines could have theoretically prevented AD in several patients with BAV.

Original languageEnglish (US)
Pages (from-to)1668-1674
Number of pages7
JournalHeart
Volume99
Issue number22
DOIs
StatePublished - Nov 2013

Fingerprint

Tricuspid Valve
Aortic Valve
Dissection
Aortic Valve Stenosis
Dilatation
Aortic Coarctation
Hypertension
Bicuspid Aortic Valve
Aorta
Atherosclerosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{85892bf3db9f444a929fbd1f83bbb531,
title = "Type A aortic dissection in patients with bicuspid aortic valves: Clinical and pathological comparison with tricuspid aortic valves",
abstract = "Objective Bicuspid aortic valve (BAV) is associated with a higher risk of type A aortic dissection (AD) compared with tricuspid aortic valve (TAV). We sought to study differences between patients with BAV and TAV with AD. Design and setting Observational descriptive analysis of clinical, imaging and pathological characteristics of all patients with confirmed BAV and AD from 1980-2010, compared with a consecutive TAV group with AD. Results Of 47 patients with BAV (mean age 58±14, 77{\%} male), 31 (66{\%}) had acute AD, 16 (34{\%}) had chronic AD, 40 (85{\%}) had typical BAV, 32 (68{\%}) had hypertension and 11 (23{\%}) had previous aortic coarctation repair. Of 53 patients with TAV (mean age 66±13 ( p=0.007), 76{\%} male), 34 (66{\%}) had acute AD (p=1.0) and 46 (87{\%}) had hypertension (p=0.03). More patients with BAV had known aortic dilatation prior to AD (49{\%} versus 17{\%}, p=0.001). Presentation symptoms were identical between groups (p=NS). Maximal ascending aortic diameter at AD was higher in patients with BAV (66±15 mm vs 56±11 mm, p=0.0004). Previous aortic valve replacement (AVR) was more common in BAV (23{\%} vs 6{\%}, p=0.02). Of 11 patients with BAV with previous isolated AVR, 7 had >moderate ascending aorta dilatation at the time of surgery. Patients with BAV had increased aortic jet velocity (28{\%} vs 10{\%}) and more severe aortic stenosis (19{\%} vs 0{\%}) at presentation (p=0.04 and 0.002, respectively). In acute AD, aortic medial degeneration affected 75{\%} of BAV specimens and 41{\%} TAV specimens (p=0.01) while aortic atherosclerosis was more frequent in TAV (56{\%} vs 26{\%}, p=0.02). Conclusions Compared with patients with TAV, patients with BAV with type A AD are younger, have less hypertension, more valve stenosis and previous AVR, higher maximal aortic dimension, worse aortic medial degeneration, high prevalence of aortic coarctation, and 1 out of 2 have known aortic dilatation prior to AD. Implementation of current guidelines could have theoretically prevented AD in several patients with BAV.",
author = "Mackram Eleid and Inga Forde and Edwards, {William D.} and Joseph Maleszewski and Suri, {Rakesh M.} and Schaff, {Hartzell V} and Sarano, {Maurice E} and Michelena, {Hector I}",
year = "2013",
month = "11",
doi = "10.1136/heartjnl-2013-304606",
language = "English (US)",
volume = "99",
pages = "1668--1674",
journal = "Heart",
issn = "1355-6037",
publisher = "BMJ Publishing Group",
number = "22",

}

TY - JOUR

T1 - Type A aortic dissection in patients with bicuspid aortic valves

T2 - Clinical and pathological comparison with tricuspid aortic valves

AU - Eleid, Mackram

AU - Forde, Inga

AU - Edwards, William D.

AU - Maleszewski, Joseph

AU - Suri, Rakesh M.

AU - Schaff, Hartzell V

AU - Sarano, Maurice E

AU - Michelena, Hector I

PY - 2013/11

Y1 - 2013/11

N2 - Objective Bicuspid aortic valve (BAV) is associated with a higher risk of type A aortic dissection (AD) compared with tricuspid aortic valve (TAV). We sought to study differences between patients with BAV and TAV with AD. Design and setting Observational descriptive analysis of clinical, imaging and pathological characteristics of all patients with confirmed BAV and AD from 1980-2010, compared with a consecutive TAV group with AD. Results Of 47 patients with BAV (mean age 58±14, 77% male), 31 (66%) had acute AD, 16 (34%) had chronic AD, 40 (85%) had typical BAV, 32 (68%) had hypertension and 11 (23%) had previous aortic coarctation repair. Of 53 patients with TAV (mean age 66±13 ( p=0.007), 76% male), 34 (66%) had acute AD (p=1.0) and 46 (87%) had hypertension (p=0.03). More patients with BAV had known aortic dilatation prior to AD (49% versus 17%, p=0.001). Presentation symptoms were identical between groups (p=NS). Maximal ascending aortic diameter at AD was higher in patients with BAV (66±15 mm vs 56±11 mm, p=0.0004). Previous aortic valve replacement (AVR) was more common in BAV (23% vs 6%, p=0.02). Of 11 patients with BAV with previous isolated AVR, 7 had >moderate ascending aorta dilatation at the time of surgery. Patients with BAV had increased aortic jet velocity (28% vs 10%) and more severe aortic stenosis (19% vs 0%) at presentation (p=0.04 and 0.002, respectively). In acute AD, aortic medial degeneration affected 75% of BAV specimens and 41% TAV specimens (p=0.01) while aortic atherosclerosis was more frequent in TAV (56% vs 26%, p=0.02). Conclusions Compared with patients with TAV, patients with BAV with type A AD are younger, have less hypertension, more valve stenosis and previous AVR, higher maximal aortic dimension, worse aortic medial degeneration, high prevalence of aortic coarctation, and 1 out of 2 have known aortic dilatation prior to AD. Implementation of current guidelines could have theoretically prevented AD in several patients with BAV.

AB - Objective Bicuspid aortic valve (BAV) is associated with a higher risk of type A aortic dissection (AD) compared with tricuspid aortic valve (TAV). We sought to study differences between patients with BAV and TAV with AD. Design and setting Observational descriptive analysis of clinical, imaging and pathological characteristics of all patients with confirmed BAV and AD from 1980-2010, compared with a consecutive TAV group with AD. Results Of 47 patients with BAV (mean age 58±14, 77% male), 31 (66%) had acute AD, 16 (34%) had chronic AD, 40 (85%) had typical BAV, 32 (68%) had hypertension and 11 (23%) had previous aortic coarctation repair. Of 53 patients with TAV (mean age 66±13 ( p=0.007), 76% male), 34 (66%) had acute AD (p=1.0) and 46 (87%) had hypertension (p=0.03). More patients with BAV had known aortic dilatation prior to AD (49% versus 17%, p=0.001). Presentation symptoms were identical between groups (p=NS). Maximal ascending aortic diameter at AD was higher in patients with BAV (66±15 mm vs 56±11 mm, p=0.0004). Previous aortic valve replacement (AVR) was more common in BAV (23% vs 6%, p=0.02). Of 11 patients with BAV with previous isolated AVR, 7 had >moderate ascending aorta dilatation at the time of surgery. Patients with BAV had increased aortic jet velocity (28% vs 10%) and more severe aortic stenosis (19% vs 0%) at presentation (p=0.04 and 0.002, respectively). In acute AD, aortic medial degeneration affected 75% of BAV specimens and 41% TAV specimens (p=0.01) while aortic atherosclerosis was more frequent in TAV (56% vs 26%, p=0.02). Conclusions Compared with patients with TAV, patients with BAV with type A AD are younger, have less hypertension, more valve stenosis and previous AVR, higher maximal aortic dimension, worse aortic medial degeneration, high prevalence of aortic coarctation, and 1 out of 2 have known aortic dilatation prior to AD. Implementation of current guidelines could have theoretically prevented AD in several patients with BAV.

UR - http://www.scopus.com/inward/record.url?scp=84885857106&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84885857106&partnerID=8YFLogxK

U2 - 10.1136/heartjnl-2013-304606

DO - 10.1136/heartjnl-2013-304606

M3 - Article

C2 - 24006455

AN - SCOPUS:84885857106

VL - 99

SP - 1668

EP - 1674

JO - Heart

JF - Heart

SN - 1355-6037

IS - 22

ER -