The Congenitally Malformed Aortic Valve in Type A Aortic Dissection: Its Frequency and Consequences

Area of Science:

• Cardiovascular Surgery
• Cardiac Pathology
• Medical Genetics

Background:

• Congenital aortic valve malformations, including unicuspid (UAV) and bicuspid (BAV) aortic valves, affect approximately 1% of the population.
• These valve abnormalities are recognized as a potential risk factor for aortic dissection.
• Understanding the association between aortic valve morphology and aortic dissection is crucial for risk stratification and management.

Purpose of the Study:

• To investigate the prevalence and clinical implications of congenital aortic valve malformations in patients with spontaneous, acute type A aortic dissection.
• To compare the characteristics and outcomes of aortic dissection in patients with normal versus abnormal aortic valves.

Main Methods:

• Retrospective analysis of clinical and operative findings in 134 patients with acute type A aortic dissection.
• Classification of aortic valve morphology (normal, BAV, UAV).
• Comparison of demographic data, malperfusion classification, aortic root dimensions, entry tear location, and histological findings between groups.

Main Results:

• Abnormal aortic valves (BAV or UAV) were present in 8% of patients with type A aortic dissection, an eightfold increase compared to the general population.
• Patients with UAV/BAV had a higher incidence of aortic root aneurysm (64% vs. 18%) and larger aortic root diameter.
• The entry tear was more frequently located in the proximal zone 0 in the UAV/BAV group (91% vs. 62%).
• Systemic hypertension was less frequent in the UAV/BAV group.

Conclusions:

• Congenital aortic valve malformations are significantly associated with acute type A aortic dissection.
• Aortic root aneurysm and proximal entry tear location are more common in patients with UAV/BAV and aortic dissection.
• These findings highlight the importance of assessing aortic valve morphology in patients with aortic dissection.