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Cause of Ascending Aortic Dilatation in Patients with Bicuspid Aortic Valves: The Final Link

Francis Robicsek1, Jeko M Madjarov1, Robert F Padera2

  • 1Department of Thoracic and Cardiovascular Surgery, Sanger Heart and Vascular Institute, Carolinas Medical Centre, Charlotte, North Carolina, United States.

The Thoracic and Cardiovascular Surgeon
|November 30, 2018
PubMed

Insights

Congenital bicuspid aortic valves (CBAVs) cause ascending aorta dilatation due to turbulent blood flow, not genetics, in most cases. Aortic wall structure is normal at birth when CBAV is the only defect.

Area of Science:

  • Cardiovascular Medicine
  • Medical Genetics
  • Biomedical Engineering

Background:

  • Congenital bicuspid aortic valves (CBAVs) are associated with ascending aorta dilatation.
  • The etiology of this dilatation is debated, with theories including genetic factors and turbulent blood flow.
  • Previous research indicated CBAVs can cause inherent morphological stenosis, even without significant pressure gradients.

Purpose of the Study:

  • To investigate the cause of ascending aorta dilatation in patients with CBAVs.
  • To differentiate between genetic and hemodynamic factors contributing to aortic dilatation.
  • To reinforce the concept of poststenotic dilatation in CBAV patients.

Main Methods:

  • Studied aortic wall structure in newborns with CBAV.
  • Compared infants with CBAV as the sole anomaly versus those with additional cardiovascular defects.

Main Results:

  • Aortic wall structure was normal at birth in infants with CBAV as the only cardiac anomaly.
  • Aortic wall structure was abnormal at birth if additional cardiovascular anomalies were present alongside CBAV.

Conclusions:

  • Ascending aorta dilatation in CBAV patients, when CBAV is the sole anomaly, is primarily due to poststenotic dilatation caused by turbulent blood flow.
  • The presence of additional cardiovascular anomalies may exacerbate aortic dilatation through genetic abnormalities of the aortic wall.
Abstract

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