Original investigationQuantitative Assessment of Asymmetric Aortic Dilation with Valve-related Aortic Disease
Section snippets
Patient Selection
Computed tomographic and magnetic resonance angiographic images of the thorax were retrospectively reviewed to identify patients in six groups. Four groups with aortic dilation were studied: those with tricuspid aortic valves (TAVs) with and without stenosis and those with BAVs with and without stenosis. The two control groups had either TAVs or BAVs without aortic stenosis or dilation. Waiver of informed consent was obtained from our institutional review board for this retrospective study,
Patient Characteristics
A total of 105 patients were identified. Patient demographics and clinical information are described in Table 1. Among subjects with TAVs, 34 patients with and 25 controls without AsAo dilation were selected. The mean age was 69.6 ± 9.54 years for patients with dilation and 53.7 ± 17.4 years for controls (P < .01). Of the patients with TAVs and dilated ascending aortas (n = 34), nine had aortic stenosis. Among subjects with BAVs, 22 patients with and 24 controls without AsAo dilation were
Discussion
We demonstrate that asymmetric dilation of the ascending aorta, with relative bulging of the greater curvature, is not only linked to aortic stenosis but is also seen with nonstenotic BAVs. The superior 3D abilities of CTA and MRA allowed the quantification of this aortic asymmetry using a ratio of the greater to lesser AsAo curvatures.
CTA and MRA allow the evaluation of the entire ascending aorta, in contrast to echocardiography, with which the superior extent of dilation often is not
Conclusions
We used the superior 3D capabilities of CTA and MRA to demonstrate a unique, asymmetric shape of AsAo dilation that is linked to aortic valve disease. This asymmetry is seen not only in the setting of aortic stenosis but also with nonstenotic BAV. This suggests that the hemodynamic forces that contribute to aortic dilation are not fully revealed by conventional assessment of the aortic valve. Follow-up is needed to determine whether aortic morphology and assessment of underlying abnormal
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2018, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :By “asymmetric dilatation,” predominant enlargement of the greater, outer curvature (usually referred to by the misnomer “convexity” as opposite to the lesser, inner curvature or “concavity”) of the tubular aorta is meant. Preoperative imaging methods can be used to identify asymmetric aneurysms.94,95 Several studies found a significant correlation between functional BAV lesion (ie, BAV-AS) and asymmetric dilatation of the tubular aorta.95,96
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2016, Annals of Thoracic SurgeryCitation Excerpt :Hemodynamic modeling and four-dimensional flow (phase contrast) magnetic resonance imaging of BAV patients have demonstrated turbulent flow patterns suggesting increased wall shear stress in the greater curvature of the ascending aorta in BAV patients [15–17]. BAV patients tend toward asymmetric dilatation of the proximal ascending aorta, particularly with type 1 morphotypes [4–6, 15, 27–29], localized to the greater curvature, whereas TAAs in TAV patients tend toward a more uniform, symmetrical dilatation pattern. Furthermore, differential expression of extracellular matrix proteins important to vessel wall integrity was found in the greater curvature of aortic specimens from BAV patients [30, 31].
4D Flow MRI Applications for Aortic Disease
2015, Magnetic Resonance Imaging Clinics of North AmericaCitation Excerpt :Abnormal hemodynamics and intrinsic aortic wall disease both likely play a role in the development of aortic dilation with BAV, with the relative contribution of each factor debated in the literature.26 The asymmetry of ascending aortic dilation that is typically seen with BAV, where there is disproportionate dilation of the aortic convexity, suggests an underlying asymmetric driver of disease.27 4D Flow research has focused on identifying hemodynamic markers that may be responsible for this dilation pattern and be used to predict disease progression.
Feasibility of asymmetric stretch assessment in the ascending aortic wall with DENSE cardiovascular magnetic resonance
2014, Journal of Cardiovascular Magnetic ResonanceImplications of Bicuspid Aortic Valve Disease and Aortic Stenosis/Insufficiency as Risk Factors for Thoracic Aortic Aneurysm
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