How common is aortic dilatation?

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Aortic dilatation is most commonly associated with hypertension, bicuspid aortic valve and connective tissue diseases such as Marfan’s. It is a precursor to life threatening complications such as rupture or dissection of the aorta. The current ESC Guidelines recommend surgical intervention once the aortic diameter is >50 mm in patients with Marfan syndrome (Ic) and >55 mm in patients with a bicuspid or normal aortic valve morphology (IIb). There is currently a lack of literature on the prevalence of aortic dilatation in the general or even hospital population although there is historical data suggesting the incidence of thoracic aortic aneurysm to be 5.9 cases per 100,000. Purpose The aim is to investigate the prevalence of aortic dilatation by echocardiography in our hospital population which may help lay the foundation for population studies and identify prognostic factors which may determine the time of surgical intervention. Methods We carried out a retrospective survey using the digital echocardiogram archive and the electronic patient record system at our hospital. This survey covered the period between 1st October 2016 and 1st November 2018. For randomisation purposes, all transthoracic echocardiograms (TTE) performed on every Thursday during this period were included. All patients with an echocardiographic report of aortic root or ascending aorta dilatation were enrolled. Other information including echocardiographic dimensions along with demographics and past medical history was collected. Results During this 24-month period, we analysed a total of 3019 TTEs. 209 patients (6.9%) were reported to have aortic dilatation. 137 (66%) were male and the median age was 67 years. The mean height and weight were 169cm and 80kg, respectively. A bicuspid aortic valve was confirmed in 10 (4.8%) patients. 132 (63%) patients had a history of hypertension. On echocardiogram, 75 (36%) patients had septal hypertrophy and 26 (12.4%) had a dilated left ventricle. Conclusion Our findings are unique and for the first time, to our knowledge, we report the echocardiographic prevalence of aortic dilatation in the hospital population (6.9%). It is a staggering 40-fold increase when compared to the the prevalence of aortic aneurysm, the most likely end point of aortic dilatation. Based on our figures, there would be at least 400 patients with a dilated aorta in a year in our hospital alone. The prevalence of bicuspid aortic valve in our cohort (4.8%) was nearly three times higher than the general population where it is quoted as 1-2%. Our study also emphasised the established link between hypertension and aortic dilatation with an increased frequency in our cohort (63%) compared to the global prevalence (31%). Given the devastating sequelae of aortic dilatation and its increased prevalence in our patient population, it will be very important to keep these patients under routine surveillance and particularly those with hypertension.

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Aortic Dilatation in Patients With Bicuspid Aortic Valve

Frontiers in Physiology ◽

10.3389/fphys.2021.615175 ◽

2021 ◽

Vol 12 ◽

Author(s):

Jing Wang ◽

Wenhui Deng ◽

Qing Lv ◽

Yuman Li ◽

Tianshu Liu ◽

...

Keyword(s):

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Surgical Intervention ◽

Current Knowledge ◽

Aortic Diameter ◽

Aortic Dilatation ◽

Frequent Monitoring ◽

Increased Risk ◽

Clinically Significant ◽

Medical Burden

Bicuspid aortic valve (BAV) is the most common congenital cardiac abnormality. BAV aortic dilatation is associated with an increased risk of adverse aortic events and represents a potentially lethal disease and hence a considerable medical burden. BAV with aortic dilatation warrants frequent monitoring, and elective surgical intervention is the only effective method to prevent dissection or rupture. The predictive value of the aortic diameter is known to be limited. The aortic diameter is presently still the main reference standard for surgical intervention owing to the lack of a comprehensive understanding of BAV aortopathy progression. This article provides a brief comprehensive review of the current knowledge on BAV aortopathy regarding clinical definitions, epidemiology, natural course, and pathophysiology, as well as hemodynamic and clinically significant aspects on the basis of the limited data available.

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Bicuspid aortic valve syndrome and fibrillinopathies: potential impact on clinical approach

International Cardiovascular Forum Journal ◽

10.17987/icfj.v1i4.45 ◽

2015 ◽

Vol 1 (4) ◽

pp. 167 ◽

Cited By ~ 4

Author(s):

Guglielmina Pepe ◽

Rosina De Cario ◽

Elena Sticchi ◽

Betti Giusti ◽

Rosanna Abbate ◽

...

Keyword(s):

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Fold Increase ◽

Connective Tissue Disorder ◽

Clinical Approach ◽

Aortic Dilatation ◽

Histological Changes ◽

Fibrillin 1 ◽

Potential Impact

Bicuspid aortic valve (BAV) is a common heterogeneous disorder whose natural history is determined by hemodynamic valvular impairment and/or increased prevalence of aortic abnormalities ranging from dilatation to aneurysm and dissection. BAV-related aortopathy is frequently associated with relevant aortic pathologic changes leading to structural alterations, characteristic degenerative lesions and histological changes of the aorta very similar to those identified and described in patients with Marfan syndrome (MFS), an inherited connective tissue disorder associated with mutations in fibrillin 1 (FBN1) gene in more than 90% of patients. Recently, a 4-fold increase in the prevalence of BAV in MFS patients has been reported. Subsequently, pathogenetic FBN1 mutations in patients with BAV and aortic dilatation/aneurysm in whom MFS and other more severe type 1 fibrillinopathies were clinically excluded have been identified. In this review we discuss how this evidence, together with that of the wide heterogeneity in pathogenetic mechanisms of BAV-related aortopathy, may impact the clinical management of BAV.

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Intraoperative Detection of Ascending Aortic Dissection by Transesophageal Echocardiography in a Patient with Bicuspid Aortic Valve and Ascending Aortic Aneurysm

Journal of Perioperative Echocardiography ◽

10.5005/jp-journals-10034-1032 ◽

2015 ◽

Vol 3 (1) ◽

pp. 29-31

Author(s):

Rajkumar K Vishwakarma

Keyword(s):

Aortic Valve ◽

Aortic Aneurysm ◽

Aortic Dissection ◽

Transesophageal Echocardiography ◽

Bicuspid Aortic Valve ◽

Ascending Aorta ◽

Aortic Dilatation ◽

Ascending Aortic Aneurysm ◽

Intraoperative Detection ◽

High Index Of Suspicion

ABSTRACT Bicuspid aortic valve is a common congenital heart defect frequently associated with complications of aortic valve and dilatation of ascending aorta. High index of suspicion is required for diagnosis of aortic dissection in patient with bicuspid aortic valve and ascending aortic dilatation. We present a case of bicuspid aortic valve with ascending aortic aneurysm in which aortic dissection was detected by intraoperative transesophageal echocardiography (TEE). A careful review of patient's preoperative computed tomography (CT) scan showed dissection flap in the ascending aorta, which was overlooked in CT reporting. We present how intraoperative TEE helped in surgical planning for the patient. How to cite this article Vishwakarma RK, Raj R, Puri GD. Intraoperative Detection of Ascending Aortic Dissection by Transesophageal Echocardiography in a Patient with Bicuspid Aortic Valve and Ascending Aortic Aneurysm. J Perioper Echocardiogr 2015;3(1):29-31.

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