scholarly journals Natural history of the aortic wall changes in adults with the degenerative tricuspid aortic valve stenosis: The morphometric proofs and implications for echocardiography

2019 ◽  
Vol 76 (3) ◽  
pp. 241-258
Author(s):  
Sasa Borovic ◽  
Milica Labudovic-Borovic ◽  
Vera Todorovic ◽  
Jelena Rakocevic ◽  
Jelena Marinkovic-Eric ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Stenosis ◽  
Aortic Wall ◽  
Ascending Aorta ◽  
Morphological Data ◽  
Histopathological Changes ◽  
Tricuspid Aortic Valve ◽  
Hemodynamic Stress ◽  
Sinus Valsalvae ◽  
Echocardiographic Parameters

Background/Aim. So far, no study has been focused exclusively on the tricuspid aortic valve stenosis (TAV) in the aorta without severe dilatation and none has aimed at correlating the high mycroscopy findings with the echocardiographic parameters. This research was conducted on the postulate that detecting the histopathological changes of different severity in the aortic wall could tailor decision about an aortic surgery. The aim of this study was to grade the histopathological changes in the wall of the nonseverely dilated ascending aorta in patients with the severe, calcific TAV stenosis and to correlate them with the echocardiographic parameters in order to analyze when the ascending aorta should be replaced simultaneously with the aortic valve replacement (AVR). Methods. The samples from 37 patients subjected to the AVR and the samples from the control group were analyzed morphologically. The echocardiographic parameters obtained in the TAV stenosis patients were preoperatively correlated with the morphological data, age and gender, diameters of the ventriculo-aortic junction (AA), the sinus Valsalvae (SV) and sinotubular junction (STJ), the largest diameter of the visualized ascending aorta (AscA), the sinus Valsalvae index (SVI) and AscA/AA index. Results. We confirmed morphometrically the exact region of the hemodynamic stress influence with the mathematical distinction in comparison to the controls. In this region, the gradual elastic lamellae disruption was proved by a statistically significant difference through the 3 grades. The elastic skeleton alterations were potentiated with aging and in females. The morphometric parameters of the ascending aorta wall statistically significantly correlated with the echocardiographic parameters: AA, SV, AscA and SVI. The echocardiographic parameters tended to be higher in the most severe grade 3, in the patients younger than 65 years of age. The AscAof more than 4.5 cm was associated with the irreversible morphological defects in these patients. Conclusion. The hemodynamic stress induced by the TAV stenosis leads to the ascending aorta elastic lamellae disruption that could be histopathologically graded and correlated with the echocardiographic parameters of the ascending aorta providing a potential tool for decision-making process in cases when the ascending aorta replacement is considered simultaneously with the AVR.

scholarly journals Turbulent kinetic energy in the ascending aorta is greater in bicuspid than tricuspid aortic valve stenosis

2015 ◽  
Vol 17 (S1) ◽  
Author(s):  
Margaret Loudon ◽  
Malenka M Bissell ◽  
Petter Dyverfeldt ◽  
Carl Johan Carlhall ◽  
Tino Ebbers ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Kinetic Energy ◽  
Turbulent Kinetic Energy ◽  
Aortic Valve Stenosis ◽  
Ascending Aorta ◽  
Tricuspid Aortic Valve

scholarly journals Impact of Mild Aortic Valve Disease on Late Outcomes after Replacement of the Ascending Aorta Case-control Study

2021 ◽  
Author(s):  
Ken Nakamura ◽  
Kouan Orii ◽  
Taichi Kondo ◽  
Mitsutaka Nakao ◽  
Makoto Wakatabe ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Stenosis ◽  
Aortic Valve Disease ◽  
Ascending Aorta ◽  
Valve Disease ◽  
Aortic Valve Area ◽  
Valve Regurgitation ◽  
Aortic Valve Regurgitation ◽  
Tricuspid Aortic Valve ◽  
Valve Area

Abstract Background: The time course of mild aortic valve disease after replacement of the ascending aorta is unclear. We sought to clarify it.Methods: Between January 2011 and December 2016, 26 patients (9 bicuspid and 17 tricuspid aortic valve disease) underwent replacement of the enlarged ascending aorta alone. We compared the postoperative disease course between bicuspid and tricuspid aortic valve by transthoracic echocardiography and computed tomography performed at 73 ± 23 and 60 ± 23 months post-surgery, respectively.Results: The bicuspid group was younger than the tricuspid group (62.1 ± 4.8 vs 73.3 ± 4.8 years). Pathophysiology predominantly involved aortic valve stenosis and regurgitation in the bicuspid and tricuspid group, respectively. The peak and mean pressure gradient increased (P = .16, and P = .46) and the aortic valve area decreased significantly in the bicuspid group (P = .005). Two patients in the bicuspid group who required re-operation had an aortic valve area of 1.2 cm2 at initial operation. Seventy percent of patients in the tricuspid group had less than mild aortic valve regurgitation preoperatively, which improved up to 82% at follow-up. Freedom from re-operation was 66.7% and 100% at 8 years for the bicuspid and tricuspid group, respectively. Conclusions: Aortic valve replacement may be considered for patients with bicuspid aortic valve stenosis if the aortic valve area is less than 1.2 cm2, even if the general diagnosis is mild aortic valve stenosis at initial surgery. Even mild aortic valve regurgitation may be improved by surgical intervention in the ascending aorta.

Histopathological changes in dilated ascending aorta associated with aortic valve cuspidity

2020 ◽  
Author(s):  
Mikita Karalko ◽  
Vaclav Stejskal ◽  
Martin Dergel ◽  
Jan Gofus ◽  
Salifu Timbilla ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Wall ◽  
Elective Surgery ◽  
Ascending Aorta ◽  
Elastic Fibre ◽  
Aortic Diameter ◽  
Histopathological Changes ◽  
Clinical Database ◽  
Aneurysmal Dilation ◽  
Matrix Accumulation

Abstract OBJECTIVES Patients with a bicuspid aortic valve (BAV) often present with a dilated ascending aorta. However, the underlying pathogenesis for the observed changes in the aortic wall and the resulting aneurysmal dilation remains a subject of debate. This study aims to compare the histological abnormalities of the ascending aorta in BAV and tricuspid aortic valve (TAV) patients and their correlation with aortic diameter and patient age. METHODS A total of 376 patients from our institution’s clinical database were included in the retrospective analysis. These patients underwent either elective surgery for ascending aorta dilation or emergency surgery for aortic dissection, either isolated or with a structurally diseased aortic valve. After excision, the ascending aorta samples were analysed by a pathologist. RESULTS On histological examination, a higher degree of elastic fibre fragmentation and loss and mucoid extracellular matrix accumulation was present in the samples from TAV patients when compared with that from BAV patients (P < 0.001). However, correlation was poor for all variables when considering aortic diameter and histological abnormalities or age and histological abnormalities in both BAV and TAV patients. CONCLUSIONS Our study demonstrates a greater incidence of severe histological abnormalities in TAV patients when compared with BAV patients.

Different Hemodynamic Stress of the Ascending Aorta Wall in Patients with Bicuspid and Tricuspid Aortic Valve

2006 ◽  
Vol 21 (3) ◽  
pp. 218-220 ◽  
Author(s):  
Matthias Bauer ◽  
Henryk Siniawski ◽  
Miralem Pasic ◽  
Beate Schaumann ◽  
Roland Hetzer
Keyword(s):  
Aortic Valve ◽  
Ascending Aorta ◽  
Tricuspid Aortic Valve ◽  
Aorta Wall ◽  
Hemodynamic Stress

scholarly journals Bicuspid aortic valve morphology and aortic valvular outflow jets: an experimental analysis using an MRI-compatible pulsatile flow circulation system

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kaoru Hattori ◽  
Natsuki Nakama ◽  
Jumpei Takada ◽  
Gohki Nishimura ◽  
Ryo Moriwaki ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Pulsatile Flow ◽  
Aortic Wall ◽  
Ascending Aorta ◽  
Circulation System ◽  
Resonance Imaging ◽  
Left Posterior ◽  
Flow Circulation ◽  
The Right

AbstractThe characteristics of aortic valvular outflow jet affect aortopathy in the bicuspid aortic valve (BAV). This study aimed to elucidate the effects of BAV morphology on the aortic valvular outflow jets. Morphotype-specific valve-devising apparatuses were developed to create aortic valve models. A magnetic resonance imaging-compatible pulsatile flow circulation system was developed to quantify the outflow jet. The eccentricity and circulation values of the peak systolic jet were compared among tricuspid aortic valve (TAV), three asymmetric BAVs, and two symmetric BAVs. The results showed mean aortic flow and leakage did not differ among the five BAVs (six samples, each). Asymmetric BAVs demonstrated the eccentric outflow jets directed to the aortic wall facing the smaller leaflets. In the asymmetric BAV with the smaller leaflet facing the right-anterior, left-posterior, and left-anterior quadrants of the aorta, the outflow jets exclusively impinged on the outer curvature of the ascending aorta, proximal arch, and the supra-valvular aortic wall, respectively. Symmetric BAVs demonstrated mildly eccentric outflow jets that did not impinge on the aortic wall. The circulation values at peak systole increased in asymmetric BAVs. The bicuspid symmetry and the position of smaller leaflet were determinant factors of the characteristics of aortic valvular outflow jet.

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