Bicuspid aortic valve related aortopathy

Published on Jan 1, 2019in The Japanese Journal of Thoracic and Cardiovascular Surgery
· DOI :10.1007/s11748-017-0821-x
Sina Stock4
Estimated H-index: 4
Salah A Mohamed14
Estimated H-index: 14
Hh Sievers33
Estimated H-index: 33
Bicuspid aortic valve related aortopathy is known to significantly increase the risk for catastrophic aortic events and, therefore, represents a considerable health burden. Albeit of ongoing research in this field including genetic, molecular, hemodynamic and morphologic aspects, bicuspid aortic valve related aortopathy still represents an imperfectly understood disorder. This lack in knowledge results in a lack of consistency considering different therapeutic approaches. Recent studies have provided new insights into the etiology and clinical impacts of bicuspid aortic valve related aortopathy in different clinical settings, leading to a growing body of opinion towards a more individualized surgical approach than currently provided by the guidelines. Especially valvular hemodynamics—stenosis and regurgitation—seem to have significant impact on the development of bicuspid aortic valve related aortopathy. In this context, there is evidence that regurgitation of bicuspid aortic valves is the more fatal pathomechanism. Furthermore, “age” represents an aspect that should be taken into account when deciding whether to replace the aorta or not, because the diameter depends mainly on a patients age. The same diameter of the aorta in a 70-year old and a 20-year old patient has to be interpreted differently and should, therefore, result in different therapeutic strategies.
  • References (85)
  • Citations (3)
#1Evaldas GirdauskasH-Index: 16
#2Mina RoumanH-Index: 7
Last. Thomas KuntzeH-Index: 20
view all 9 authors...
Background Bicuspid aortic valve (BAV)–associated aortopathy is heterogeneous and still insufficiently defined. We prospectively analyzed the morphologic and functional variables of aortopathy in patients undergoing operations for BAV insufficiency (BAV-AI) vs stenosis (BAV-AS). Methods A total of 172 consecutive patients (71% male, 59 ± 10 years) underwent aortic valve replacement with or without proximal aortic operation for BAV-AS (n = 137), and BAV-AI (n = 35) from January 2012 through Decem...
10 CitationsSource
#1Nastaran Shahmansouri (McGill University)H-Index: 5
#2Mohammed Alreshidan (McGill University)H-Index: 3
Last. Rosaire Mongrain (McGill University)H-Index: 19
view all 7 authors...
Abstract Ascending thoracic aortic aneurysms (ATAAs) can lead to a dissection or rupture of the aorta, causing death or disability of the patients. Surgical interventions used to treat this disease are associated with risks of mortality and morbidity. Several studies have investigated the rupture mechanisms of ATAAs; however, underlying reasons behind aortic rupture (failure) have not been fully elucidated and further investigations are necessary. The rupture of pathological aortic tissue is a l...
11 CitationsSource
#1Alexander Navarrete Santos (MLU: Martin Luther University of Halle-Wittenberg)H-Index: 16
#2Junfeng YanH-Index: 2
Last. Salah A MohamedH-Index: 14
view all 9 authors...
Dilatation of the ascending aorta is a common occurrence in patients with bicuspid aortic valve (BAV). The aim of the current study was to characterize collagen content in advanced glycation end products (AGEs) of dilated aortic tissue from two distinct areas, concave and convex aortic sites in patients with BAV and TAV. Collagen contents extracted from 100 mg tissue was isolated by enzymatic digestion using pepsin and the nondigested material was further digested using cyanogen bromide, insolub...
1 CitationsSource
#1Jiao Jiao (UM: University of Michigan)H-Index: 6
#2Wei Xiong (UM: University of Michigan)H-Index: 2
Last. Bo Yang (UM: University of Michigan)H-Index: 12
view all 10 authors...
Individuals with bicuspid aortic valves (BAV) are at a higher risk of developing thoracic aortic aneurysms (TAA) than patients with trileaflet aortic valves (TAV). The aneurysms associated with BAV most commonly involve the ascending aorta and spare the descending aorta. Smooth muscle cells (SMCs) in the ascending and descending aorta arise from neural crest (NC) and paraxial mesoderm (PM), respectively. We hypothesized defective differentiation of the neural crest stem cells (NCSCs)-derived SMC...
27 CitationsSource
3 CitationsSource
#1Jie Wu (HMU: Harbin Medical University)H-Index: 8
#2Hui-Fang Song (Shanxi Medical University)H-Index: 4
Last. Ren-Ke Li (U of T: University of Toronto)H-Index: 41
view all 13 authors...
Abstract Background Patients with a bicuspid aortic valve (BAV) are at increased risk for progressive aortic dilation associated with extracellular matrix (ECM) degradation by matrix metalloproteinases (MMP). However, the mechanisms responsible for initiating this process are unknown. In the heart, MMP activity is regulated by micro-ribonucleic acid-17 (miR-17)–related downregulation of tissue inhibitors of metalloproteinases (TIMP); a similar process may exist in the aorta. Objectives This stud...
26 CitationsSource
#1Alkiviadis Tsamis (University of Pittsburgh)H-Index: 13
#2Julie A. PhillippiH-Index: 17
Last. Thomas G. GleasonH-Index: 28
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Abstract Objective Ascending thoracic aortic aneurysm (ATAA) in patients with bicuspid aortic valve (BAV) commonly dilate asymmetrically compared with patients with tricuspid aortic valve (TAV). This discrepancy in aneurysm geometry led us to hypothesize that microarchitectural differences underlie the observed asymmetric dilatation pattern. The purpose of this study was to characterize the microarchitectural distinctions of the extracellular matrix of the 2 phenotypes with a focus on the propor...
21 CitationsSource
#1Evaldas GirdauskasH-Index: 16
#2Mina RoumanH-Index: 7
Last. Hermann ReichenspurnerH-Index: 46
view all 11 authors...
BACKGROUND: The study aim was to prospectively analyze the impact of cusp fusion pattern on aortopathy severity in patients undergoing surgery for bicuspid aortic valve (BAV) stenosis. METHODS: A total of 137 consecutive patients with BAV stenosis (93 males, 44 females; mean age 61 ± 9 years) underwent aortic valve replacement with or without concomitant aortic surgery between January 2012 and March 2015. All patients underwent preoperative cardiac magnetic resonance imaging (cMRI) in order to e...
4 Citations
#1Yongshi Wang (Fudan University)H-Index: 5
#2Boting Wu (Fudan University)H-Index: 5
Last. Xianhong Shu (Fudan University)H-Index: 10
view all 6 authors...
Background Aberrant flow pattern and congenital fragility bestows bicuspid aortic valve (BAV) with a propensity toward ascending aorta dilatation, aneurysm, and dissection. Whether isolated aortic valve replacement (AVR) can prevent further dilatation in BAV ascending aorta and what indicates concurrent aortic intervention in the case of valve operation remain controversial. Methods From June 2006 to January 2009, patients with a BAV who underwent isolated AVR were consecutively included and cat...
17 CitationsSource
Abstract Background The correlation between bicuspid aortic valve (BAV) disease and aortopathy is not fully defined. Objectives This study aimed to prospectively analyze the correlation between functional parameters of the aortic root and expression of aortopathy in patients undergoing surgery for BAV versus tricuspid aortic valve (TAV) stenosis. Methods From January 1, 2012 through December 31, 2014, 190 consecutive patients (63 ± 8 years, 67% male) underwent aortic valve replacement ± proximal...
28 CitationsSource
Cited By3
#1R.L. Winter (OSU: Ohio State University)
#2D.K. Newhard (AU: Auburn University)H-Index: 1
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Abstract An 8-month-old intact female pug was presented for evaluation and possible balloon valvuloplasty (BV) for severe aortic stenosis. A bicuspid, severely stenotic aortic valve of type 3 morphology with a supravalvar stenosis component was diagnosed, consistent with the diagnosis of atypical Shone's complex. There was severe concentric hypertrophy of the left ventricle, with increased echogenicity of the myocardium nearest to the endocardial border. Mild left atrial enlargement was observed...
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#1Amalia ForteH-Index: 14
#2Carmela Rita Balistreri (University of Palermo)H-Index: 28
Last. Bengt-Olof Nilsson (Lund University)H-Index: 23
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Polyamines are small aliphatic cationic molecules synthesized via a highly regulated pathway and involved in general molecular and cellular phenomena. Both mammalian cells and microorganisms synthesize polyamines, and both sources may contribute to the presence of polyamines in the circulation. The dominant location for microorganisms within the body is the gut. Accordingly, the gut microbiota probably synthesizes most of the polyamines in the circulation in addition to those produced by the mam...
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