PMID- 24006455
OWN - NLM
STAT- MEDLINE
DCOM- 20131211
LR  - 20221207
IS  - 1468-201X (Electronic)
IS  - 1355-6037 (Linking)
VI  - 99
IP  - 22
DP  - 2013 Nov
TI  - Type A aortic dissection in patients with bicuspid aortic valves: clinical and 
      pathological comparison with tricuspid aortic valves.
PG  - 1668-74
LID - 10.1136/heartjnl-2013-304606 [doi]
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.
FAU - Eleid, Mackram F
AU  - Eleid MF
AD  - Division of Cardiovascular Diseases, Mayo Clinic, , Rochester, Minnesota, USA.
FAU - Forde, Inga
AU  - Forde I
FAU - Edwards, William D
AU  - Edwards WD
FAU - Maleszewski, Joseph J
AU  - Maleszewski JJ
FAU - Suri, Rakesh M
AU  - Suri RM
FAU - Schaff, Hartzell V
AU  - Schaff HV
FAU - Enriquez-Sarano, Maurice
AU  - Enriquez-Sarano M
FAU - Michelena, Hector I
AU  - Michelena HI
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20130904
PL  - England
TA  - Heart
JT  - Heart (British Cardiac Society)
JID - 9602087
SB  - IM
MH  - Aged
MH  - Aortic Dissection/*complications/*pathology/surgery
MH  - Aortic Aneurysm, Thoracic/*complications/*pathology/surgery
MH  - Aortic Valve/*abnormalities/pathology/surgery
MH  - Bicuspid Aortic Valve Disease
MH  - Female
MH  - Heart Valve Diseases/*complications/*pathology/surgery
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
EDAT- 2013/09/06 06:00
MHDA- 2013/12/16 06:00
CRDT- 2013/09/06 06:00
PHST- 2013/09/06 06:00 [entrez]
PHST- 2013/09/06 06:00 [pubmed]
PHST- 2013/12/16 06:00 [medline]
AID - heartjnl-2013-304606 [pii]
AID - 10.1136/heartjnl-2013-304606 [doi]
PST - ppublish
SO  - Heart. 2013 Nov;99(22):1668-74. doi: 10.1136/heartjnl-2013-304606. Epub 2013 Sep 
      4.