Heart 1999;82:19-22 ( July )

Aortic root dilatation in young men with normally functioning bicuspid aortic valves

S Nistri^a, M D Sorbo^b, M Marin^b, M Palisi^b, R Scognamiglio^b, G Thiene^c

^a Sanitary Service, Regione Carabinieri Veneto, Via Brigata Padova 19, 35100 Padova, Italy, ^b Department of Cardiology, University of Padova, Padova, Italy, ^c Department of Pathology, University of Padova

Correspondence to: Lt Col Nistri. email: snistr{at}tin.it

Accepted for publication 10 February 1999

OBJECTIVETo evaluate the dimensions of the aortic root in a selected population of young males with isolated normally functioning bicuspid aortic valve.
DESIGN AND SETTINGEchocardiographic and Doppler evaluation of conscripts with bicuspid aortic valve at the time of military pre-enrolment screening in two military hospitals.
SUBJECTS AND METHODS66 consecutive young men with a normally functioning bicuspid aortic valve were studied to assess aortic size at four aortic levels: annulus, sinuses of Valsalva, supra-aortic ridge, and proximal ascending aorta; 70 consecutive normal young subjects, matched for age and body surface area, were used as controls.
RESULTSIn men with a bicuspid aortic valve, the diameter of the aortic root was significantly larger than in controls at the sinuses (3.16 (0.37) v 2.87 (0.31) cm, p < 0.001), at the supra-aortic ridge (2.64 (0.46) v 2.47 (0.28) cm, p = 0.01), and at the level of the proximal ascending aorta (3.12 (0.48) v 2.69 (0.28) cm, p < 0.001). The prevalence of aortic root dilatation was 7.5% at the annulus (5/66), 19.6% at the sinuses (13/66), 15% at the supra-aortic ridge (10/66), and 43.9% at the ascending aorta (29/66); 32 subjects (48%) had aortic root dimensions comparable with controls, while 34 (52%) had definitely abnormal aortic root dimensions.
CONCLUSIONSAortic root enlargement in people with a bicuspid aortic valve occurs independently of haemodynamic abnormalities, age, and body size. However, there appear to be different subgroups of young adults with bicuspid aortic valves, one of which is characterised by aortic dilatation, possibly caused by a congenital abnormality of the aortic wall.


Keywords: bicuspid aortic valve; aortic root dilatation

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© 1999 by Heart
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• Lopez, L., Arheart, K. L., Colan, S. D., Stein, N. S., Lopez-Mitnik, G., Lin, A. E., Reller, M. D., Ventura, R., Silberbach, M. (2008). Turner Syndrome Is an Independent Risk Factor for Aortic Dilation in the Young. Pediatrics 121: e1622-e1627 [Abstract] [Full Text]  
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• Fedak, P. W. M. (2008). Bicuspid aortic valve syndrome: heterogeneous but predictable?. Eur Heart J 29: 432-433 [Full Text]  
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• Verma, S., Szmitko, P. E., Fedak, P. W. M., Errett, L., Latter, D. A., David, T. E. (2005). Can statin therapy alter the natural history of bicuspid aortic valves?. Am. J. Physiol. Heart Circ. Physiol. 288: H2547-H2549 [Full Text]  
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• Maron, B. J., Ackerman, M. J., Nishimura, R. A., Pyeritz, R. E., Towbin, J. A., Udelson, J. E. (2005). Task Force 4: HCM and other cardiomyopathies, mitral valve prolapse, myocarditis, and Marfan syndrome. J Am Coll Cardiol 45: 1340-1345 [Full Text]  
• Lewin, M. B., Otto, C. M. (2005). The Bicuspid Aortic Valve: Adverse Outcomes From Infancy to Old Age. Circulation 111: 832-834 [Full Text]  
• Isselbacher, E. M. (2005). Thoracic and Abdominal Aortic Aneurysms. Circulation 111: 816-828 [Full Text]  
• Koullias, G. J., Korkolis, D. P., Ravichandran, P., Psyrri, A., Hatzaras, I., Elefteriades, J. A. (2004). Tissue microarray detection of matrix metalloproteinases, in diseased tricuspid and bicuspid aortic valves with or without pathology of the ascending aorta. Eur. J. Cardiothorac. Surg. 26: 1098-1103 [Abstract] [Full Text]  
• Borger, M. A., Preston, M., Ivanov, J., Fedak, P. W.M., Davierwala, P., Armstrong, S., David, T. E. (2004). Should the ascending aorta be replaced more frequently in patients with bicuspid aortic valve disease?. J. Thorac. Cardiovasc. Surg. 128: 677-683 [Abstract] [Full Text]  
• Oliver, J. M., Gallego, P., Gonzalez, A., Aroca, A., Bret, M., Mesa, J. M. (2004). Risk factors for aortic complications in adults with coarctation of the aorta. J Am Coll Cardiol 44: 1641-1647 [Abstract] [Full Text]  
• Lewin, M. B., McBride, K. L., Pignatelli, R., Fernbach, S., Combes, A., Menesses, A., Lam, W., Bezold, L. I., Kaplan, N., Towbin, J. A., Belmont, J. W. (2004). Echocardiographic Evaluation of Asymptomatic Parental and Sibling Cardiovascular Anomalies Associated With Congenital Left Ventricular Outflow Tract Lesions. Pediatrics 114: 691-696 [Abstract] [Full Text]  
• Richards, K. E., Deserranno, D., Donal, E., Greenberg, N. L., Thomas, J. D., Garcia, M. J. (2004). Influence of structural geometry on the severity of bicuspid aortic stenosis. Am. J. Physiol. Heart Circ. Physiol. 287: H1410-H1416 [Abstract] [Full Text]  
• Boyum, J., Fellinger, E. K., Schmoker, J. D., Trombley, L., McPartland, K., Ittleman, F. P., Howard, A. B. (2004). Matrix metalloproteinase activity in thoracic aortic aneurysms associated with bicuspid and tricuspid aortic valves. J. Thorac. Cardiovasc. Surg. 127: 686-691 [Abstract] [Full Text]  
• Yasuda, H., Nakatani, S., Stugaard, M., Tsujita-Kuroda, Y., Bando, K., Kobayashi, J., Yamagishi, M., Kitakaze, M., Kitamura, S., Miyatake, K. (2003). Failure to Prevent Progressive Dilation of Ascending Aorta by Aortic Valve Replacement in Patients With Bicuspid Aortic Valve: Comparison With Tricuspid Aortic Valve. Circulation 108: II-291-294 [Abstract] [Full Text]  
• Andrus, B. W., O'Rourke, D. J., Dacey, L. J., Palac, R. T. (2003). Stability of Ascending Aortic Dilatation Following Aortic Valve Replacement. Circulation 108: II-295-299 [Abstract] [Full Text]  
• Warnes, C A (2003). Bicuspid aortic valve and coarctation: two villains part of a diffuse problem. Heart 89: 965-966 [Full Text]  
• Roos-Hesselink, J W, Scholzel, B E, Heijdra, R J, Spitaels, S E C, Meijboom, F J, Boersma, E, Bogers, A J J C, Simoons, M L (2003). Aortic valve and aortic arch pathology after coarctation repair. Heart 89: 1074-1077 [Abstract] [Full Text]  
• Nkomo, V. T., Enriquez-Sarano, M., Ammash, N. M., Melton, L. J. III, Bailey, K. R., Desjardins, V., Horn, R. A., Tajik, A. J. (2003). Bicuspid Aortic Valve Associated With Aortic Dilatation: A Community-Based Study. Arterioscler. Thromb. Vasc. Bio. 23: 351-356 [Abstract] [Full Text]  
• David, T. E. (2003). Aortic Valve Repair and Aortic Valve-Sparing Operations. Card Surg Adult 2: 811-824 [Full Text]  
• Russo, C. F., Mazzetti, S., Garatti, A., Ribera, E., Milazzo, A., Bruschi, G., Lanfranconi, M., Colombo, T., Vitali, E. (2002). Aortic complications after bicuspid aortic valve replacement: long-term results. Ann. Thorac. Surg. 74: S1773-1776 [Abstract] [Full Text]  
• Fedak, P. W.M., Verma, S., David, T. E., Leask, R. L., Weisel, R. D., Butany, J. (2002). Clinical and Pathophysiological Implications of a Bicuspid Aortic Valve. Circulation 106: 900-904 [Full Text]  
• Jost, C. H. A., Schaff, H. V., Connolly, H. M., Danielson, G. K., Dearani, J. A., Puga, F. J., Warnes, C. A. (2002). Spectrum of Reoperations After Repair of Aortic Coarctation: Importance of an Individualized Approach Because of Coexistent Cardiovascular Disease. Mayo Clin Proc. 77: 646-653 [Abstract]  
• Hager, A., Kaemmerer, H., Rapp-Bernhardt, U., Blucher, S., Rapp, K., Bernhardt, T. M., Galanski, M., Hess, J. (2002). Diameters of the thoracic aorta throughout life as measured with helical computed tomography. J. Thorac. Cardiovasc. Surg. 123: 1060-1066 [Abstract] [Full Text]  
• Simon-Kupilik, N., Bialy, J., Moidl, R., Kasimir, M.-T., Mittlbock, M., Seebacher, G., Wolner, E., Simon, P. (2002). Dilatation of the autograft root after the Ross operation. Eur. J. Cardiothorac. Surg. 21: 470-473 [Abstract] [Full Text]  
• Luciani, G. B., Casali, G., Faggian, G., Mazzucco, A. (2000). Predicting outcome after reoperative procedures on the aortic root and ascending aorta. Eur. J. Cardiothorac. Surg. 17: 602-607 [Abstract] [Full Text]  
• Ward, C (2000). Clinical significance of the bicuspid aortic valve. Heart 83: 81-85 [Full Text]