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Coronary arterial anatomy in bicuspid aortic valve. Necropsy study of 100 hearts
Insights
Bicuspid aortic valves, both congenital and acquired, commonly affect the right and left cusps. Congenital cases show a higher incidence of left coronary artery dominance and variations in coronary ostium location.
Area of Science:
- Cardiovascular Pathology
- Anatomical Studies
Background:
- Bicuspid aortic valves (BAV) are a common congenital heart defect, but acquired forms also exist.
- Understanding the anatomical variations associated with BAV is crucial for surgical and clinical management.
Purpose of the Study:
- To investigate the cusp involvement and coronary artery ostium anatomy in congenital versus acquired bicuspid aortic valves.
- To compare the incidence of coronary dominance in BAV compared to normal hearts.
Main Methods:
- Necropsy study involving 50 hearts with congenital BAV and 50 with acquired BAV.
- Detailed examination of aortic cusp fusion and the origin of coronary ostia.
- Assessment of left main coronary artery length and coronary dominance patterns.
Main Results:
- The right and left aortic cusps were most frequently involved in cusp fusion for both congenital and acquired BAV.
- Left coronary ostium origin above the sinotubular junction was more common in congenital BAV (44%) than acquired BAV (20%).
- Left coronary dominance was elevated in both congenital (26%) and acquired BAV groups compared to normal hearts.
Conclusions:
- Congenital and acquired BAV exhibit distinct patterns of coronary ostium anomalies.
- Elevated left coronary dominance in BAV may be linked to underlying congenital variations or acquired fusion.
- Left main coronary artery length is influenced by coronary dominance patterns in BAV.
Abstract:
In a necropsy study, the conjoined cusps of 50 congenitally and 50 acquired bicuspid aortic valves most commonly involved the right and left aortic cusps. In hearts with congenitally bicuspid aortic valves, the left coronary ostium arose at or above the aortic sinotubular junction in 44 per cent, whereas the incidence for the left coronary ostium in the acquired group was 20 per cent and that for the right coronary ostium in both groups was less than 20 per cent. In hearts with congenitally bicuspid aortic valves, the incidence of left coronary dominance (26%) was higher than in normal hearts. In hearts with apparently acquired bicuspid aortic valves, this incidence was also higher than normal, possibly because of acquired fusion of atypical congenitally bicuspid valves in some cases. In both types of aortic valve disease, the length of the left main coronary artery was similar; this length, however, was significantly shorter in hearts with left coronary dominance than in those with right or shared dominance.