Aortic pathology in patients with bicuspid aortic valve assessed with computed tomography angiography
Ilona M Michałowska1, Mariusz Kruk, Paweł Kwiatek
1Departments of *Radiology †Coronary and Structural Heart Diseases ‡Heart Valve Diseases §Congenital Heart Disease in Adults, Institute of Cardiology ∥Department of Radiology, Centre for Postgraduate Medical Education, Warsaw, Poland.
Insights
Bicuspid aortic valve (BAV) with raphe is more common and linked to ascending aorta issues, while pure BAV is more often associated with coarctation of the aorta (CoA). This study used computed tomography to analyze these thoracic aorta pathologies.
Area of Science:
- Cardiovascular Imaging
- Thoracic Surgery
- Medical Diagnostics
Background:
- Bicuspid aortic valve (BAV) is a common congenital heart defect.
- Thoracic aorta pathologies frequently coexist with BAV.
- Understanding these associations is crucial for patient management.
Purpose of the Study:
- To evaluate thoracic aorta pathologies in patients with BAV.
- To differentiate pathologies based on BAV morphology (pure BAV vs. BAV with raphe).
- To utilize dual-source computed tomography for detailed assessment.
Main Methods:
- Retrospective analysis of 102 patients with BAV.
- ECG-gated CT angiography of the thoracic aorta.
- Characterization of BAV morphology and measurement of aortic dimensions and pathologies (dilatation, aneurysm, dissection, coarctation).
Main Results:
- BAV with raphe (73.5%) was more prevalent than pure BAV (26.5%).
- Patients with BAV with raphe showed significantly larger aortic diameters in multiple segments.
- Dilatation and aneurysm were more frequent in BAV with raphe (84.5%) vs. pure BAV (58.06%).
- Coarctation of the aorta (CoA) was significantly more prevalent in pure BAV (44.4%) compared to BAV with raphe (13.3%).
Conclusions:
- BAV with raphe is the predominant form and strongly associated with ascending aorta dilatation and aneurysm.
- Pure BAV is disproportionately linked to coarctation of the aorta (CoA).
- Morphological classification of BAV aids in predicting associated thoracic aorta pathologies.
Purpose:
The aim of the study was to assess thoracic aorta pathologies coexisting with bicuspid aortic valve (BAV) using dual-source computed tomography.
Materials And Methods:
A total of 102 patients with BAV diagnosed by electrocardiogram-gated computed tomography angiography of the thoracic aorta were analyzed retrospectively. The morphology of BAV was characterized on the basis of the presence and orientation of cusps and raphes as "pure BAV" (i.e., without raphe) or "BAV with raphe." The assessment included aortic diameters and pathologies such as dilatation, aneurysm, dissection, or coarctation (CoA).
Results:
Of the 102 patients, 75 (73.5%) had BAV with raphe, and 27 patients (26.5%) had pure BAV. The analysis revealed significant differences in the diameter of the annulus, the sinuses of Valsalva, the tubular portion of the ascending aorta, and the part of the aorta proximal to the innominate artery between patients with pure BAV and BAV with raphe (respectively 27.18±4.33 vs. 29.88±4.18 mm, P=0.005; 38.11±7.2 vs. 41.77±6.9 mm, P=0.022; 39.07±8.3 vs. 46.31±7.8 mm, P=0.0001; 30.85±6.7 vs. 34.89±5.08 mm, P=0.02). There was a significant difference in prevalence of dilatation and aneurysm of the thoracic aorta between patients with pure BAV and BAV with raphe [58.06% vs. 84.5% (18/31 vs. 60/71), P=0.004]. The prevalence of aortic CoA was higher in patients with pure BAV than in patients with BAV with raphe [44.4% vs. 13.3% (12/27 vs. 10/75), P=0.001].
Conclusions:
BAV with raphe is more common than pure BAV and is more often associated with dilatation and aneurysm of the ascending aorta. Pure BAV is more commonly associated with CoA.
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