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Ascending aortic size in aortic coarctation depends on aortic valve morphology: Understanding the bicuspid valve

Erik L Frandsen1, Luke J Burchill2, Abigail M Khan2

  • 1Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA.

International Journal of Cardiology
|November 25, 2017
PubMed

Insights

Coarctation of the aorta (CoA) patients with a tricuspid aortic valve (TAV) have smaller aortas than those with a bicuspid aortic valve (BAV). Aortic size in CoA is not linked to hypertension, suggesting BAV phenotype drives aortopathy.

Area of Science:

  • Cardiovascular Medicine
  • Medical Imaging
  • Genetics

Background:

  • Coarctation of the aorta (CoA) is frequently associated with aortic enlargement.
  • The relationship between aortic size, CoA, and aortic valve morphology remains unclear.
  • This study investigates aortic dimensions in CoA patients with tricuspid aortic valve (TAV) versus bicuspid aortic valve (BAV).

Purpose of the Study:

  • To compare aortic dimensions in patients with coarctation of the aorta (CoA) based on aortic valve morphology.
  • To determine if aortic enlargement in CoA is influenced by aortic valve type (TAV vs. BAV).
  • To assess the role of hypertension in aortic dimensions in CoA patients.

Main Methods:

  • Retrospective analysis of cardiac magnetic resonance (CMR) imaging in 68 CoA patients and 20 controls.
  • Measurement of aortic root and mid-ascending aorta diameters.
  • Comparison of aortic diameters across CoA with TAV, CoA with BAV, and control groups.

Main Results:

  • CoA patients with TAV had significantly smaller aortic root and mid-ascending aorta diameters compared to CoA patients with BAV.
  • Aortic dimensions in CoA with TAV were similar to healthy controls.
  • Aortic dilation (>37mm) occurred in 35% of CoA patients, predominantly those with BAV (79%); hypertension was not a predictor of aortic size.

Conclusions:

  • Tricuspid aortic valve in CoA is associated with smaller aortic dimensions, similar to healthy individuals.
  • Bicuspid aortic valve phenotype, not CoA or hypertension, appears to be the primary driver of aortopathy.
  • These findings may influence monitoring and treatment strategies for CoA patients.
Abstract

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