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Association between bicuspid aortic valve morphotype and regional dilatation of the aortic root and trunk

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Abstract

Thoracic aortic disease, including thoracic aortic aneurysm (TAA), is frequently seen in patients with bicuspid aortic valve (BAV). We hypothesized that BAV morphotype would be associated with aortic aneurysm phenotypes but that other patient variables would significantly modify this relationship. 829 patients between 18 and 90 years with BAV and available raw imaging of the aortic valve and the ascending aorta to its mid-portion prior to aortic valve and aortic surgery were examined. The sinuses of Valsalva and proximal ascending aorta were measured from 2-dimensional co-planar echocardiographic images. We observed strong associations between patient habitus and raw and normalized dimensions of the aortic root and ascending aorta. Patients with R–L morphotype presented at an older age with larger aortic root but similar ascending aortic dimensions. After accounting for patient morphometric characteristics and severity of aortic valve disease, patients with R–L valve morphotype were marginally more likely to have an aortic root aneurysm (86% vs. 78%; P = 0.043), defined as aortic root dimension Z score ≥3. We observed only small differences in aortic dimensions between BAV morphotypes, that are eclipsed by variation in patient habitus. We interpret these findings to mean that BAV patients will not likely benefit from therapies based on aortic valve morphotype. Rather, we propose that all BAV patients should undergo longitudinal follow-up, independent of valve morphotype. Guidelines for aortic surgery based upon dimensions alone may be improved by considering patient characteristics such as age, body size and other characteristics.

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Abbreviations

IE:

Infective endocarditis

BAV:

Bicuspid aortic valve

TAV:

Tricuspid aortic valve

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Funding

This work was funded by NIH Grants R01HL114823 (SCB) and R01HL118266 (JDM).

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Authors and Affiliations

  1. Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, 75 Francis St, Boston, MA, 02115, USA

    Karam M. Habchi, Vanessa Montiero Vieira, Jasmin T. Shahram, Jochen D. Muehlschlegel & Simon C. Body

  2. Department of Anesthesiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA

    Elena Ashikhmina

  3. Department of Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02115, USA

    Eric M. Isselbacher & Thoralf M. Sundt III

  4. Department of Surgery, Brigham and Women’s Hospital, 75 Francis St, Boston, MA, 02115, USA

    Prem Shekar

Authors
  1. Karam M. Habchi
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  2. Elena Ashikhmina
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  3. Vanessa Montiero Vieira
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  4. Jasmin T. Shahram
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  7. Prem Shekar
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  8. Jochen D. Muehlschlegel
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  9. Simon C. Body
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Consortia

Bicuspid Aortic Valve Consortium

Corresponding author

Correspondence to Simon C. Body.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Review Board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Institutional Review Board determined that individual patient consent was not required.

Appendix 1: List of BAVCon sites

Appendix 1: List of BAVCon sites

U Penn

Rita Milewski

milewskr@uphs.upenn.edu

Uruguay

Victor Dayan

Victor_dayan@hotmail.com

GenTAC

Barbara L. Kroner

byk@rti.org

Harvard

Simon Body

sbody@partners.org

Laval

Yohan Bossé

Yohan.Bosse@criucpq.ulaval.ca

Mayo

Hector I. Michelena

michelena.hector@mayo.edu

Michigan

Bo Yang

boya@med.umich.edu

Monaldi

Giuseppe Limongelli

limongelligiuseppe@libero.it

Oxford

Malenka Bissell

malenka.bissell@cardiov.ox.ac.uk

Salerno (Naples)

Eduardo Bossone

ebossone@hotmail.com

San Donato (Milan)

Francesca Pluchinotta

francesca.pluchinotta@grupposandonato.it

Second University of Naples

Alessandro Della Corte

aledellacorte@libero.it

Texas

Dianna M. Milewicz

Dianna.M.Milewicz@uth.tmc.edu

Tufts

Gordon Huggins

ghuggins@tuftsmedicalcenter.org

Vall d’Hebron (Barcelona)

Arturo Evangelista

arturevangelistamasip@gmail.com

Vanderbilt

Joshua C Denny

josh.denny@vanderbilt.edu

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Habchi, K.M., Ashikhmina, E., Vieira, V.M. et al. Association between bicuspid aortic valve morphotype and regional dilatation of the aortic root and trunk. Int J Cardiovasc Imaging 33, 341–349 (2017). https://doi.org/10.1007/s10554-016-1016-8

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  • DOI: https://doi.org/10.1007/s10554-016-1016-8

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