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Coronary Artery Dominance and Cardiovascular Pathologies in Patients with Bicuspid Aortic Valve
Nanruoyi Zhou1, Gentian Lluri2
1David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Insights
In patients with bicuspid aortic valve (BAV), right coronary artery dominance is most common. Left dominance, however, is significantly linked to coarctation of the aorta (CoA) in BAV patients.
Area of Science:
- Cardiology
- Congenital Heart Defects
- Cardiovascular Imaging
Background:
- Bicuspid aortic valve (BAV) is the most prevalent congenital heart defect.
- BAV is linked to various cardiac conditions like coarctation of the aorta (CoA), aortic dilation, stenosis, and premature coronary artery disease (CAD).
- The association between BAV and left dominant coronary artery anatomy is debated, with no prior studies exploring coronary artery dominance and cardiac pathologies in BAV patients.
Purpose of the Study:
- To investigate the association between coronary artery dominance and cardiac pathologies in patients with BAV.
- To determine the prevalence of right vs. left dominant coronary artery circulation in BAV patients.
- To assess if coronary artery dominance influences the incidence of CoA, aortic dilation, stenosis, or CAD in BAV patients.
Main Methods:
- Retrospective analysis of 45 patients with BAV.
- Coronary computed tomography angiography (CTA) and/or cardiac catheterization data were reviewed.
- Coronary artery dominance, CAD, CoA, and aortic dilation were assessed; stenosis and regurgitation were determined from echocardiography reports.
Main Results:
- 80% of BAV patients exhibited right dominant coronary circulation.
- Left dominant coronary circulation in BAV patients was significantly associated with a higher incidence of CoA (44% vs. 14%, p=0.04).
- No significant differences were found in the incidence of aortic dilation, stenosis, regurgitation, or CAD between left and right dominant BAV patients.
Conclusions:
- Right coronary artery dominance is predominant in BAV patients, aligning with the general population.
- Left coronary artery dominance shows a significant association with coarctation of the aorta in BAV patients.
- Further research is warranted to explore the relationship between coronary artery dominance and other cardiovascular pathologies in BAV.
Background:
Bicuspid aortic valve (BAV) is the most common congenital heart defect and is associated with a number of cardiac pathologies including coarctation of the aorta (CoA), aortic dilation, aortic stenosis, and premature coronary artery disease (CAD). Furthermore, BAV has been associated with left dominant coronary artery anatomy but there is still much debate regarding this association. To date, no study has investigated the association between coronary artery dominance and cardiac pathologies in patients with BAV.
Methods:
A total of 45 patients with BAV who underwent coronary computed tomography angiography (CTA) and/or cardiac catheterization at a single center were included. Coronary artery dominance, presence of CAD, CoA, and aortic dilation was determined from coronary CTA and/or cardiac catheterization reports. Incidence of aortic valve stenosis and aortic valve regurgitation was determined from echo reports.
Results:
Of the 45 patients with BAV, 80% (36) had right dominant coronary artery circulations. Patients with BAV with left dominant circulations had a significantly (p = 0.04) higher incidence of CoA compared to patients with right dominant circulations (44% vs. 14%). There was no significant difference when comparing the incidences of aortic dilation, aortic valve stenosis, aortic valve regurgitation and CAD in right and left dominant patients.
Conclusions:
Our study found a predominance of right dominant coronary artery circulation in patients with BAV, similar to the general population. Interestingly, left dominance was significantly associated with CoA in patients with BAV. This observation highlights the importance of further studies regarding how coronary artery dominance can be associated with other cardiovascular pathologies in patients with BAV.
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