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The progression of ascending aorta dilatation with both congenital bicuspid and non-bicuspid aortic stenosis.

Doctor Murray Matangi (EUD ID : 32405)
Kingston Heart Clinic
Cardiology Dept.
460 Princess Street
K7L 1C2 - Kingston Canada
Phone : +1 6135443242 - Fax : +1 6135464487
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Title : The progression of ascending aorta dilatation with both congenital bicuspid and non-bicuspid aortic stenosis
Topic : 09.08 - Echo-valvular heart disease
Category : Bedside
Option : No Options
M. Matangi1, U. Jurt1, D. Brouillard1, AM. Johri2 - (1) Kingston Heart Clinic, Kingston, Canada (2) Queen's University, Kingston, Canada
Purpose. To describe the progression of ascending aortic (AscAo) dilatation in congenital bicuspid aortic valve (CBAV) and compare that with non-bicuspid aortic valve (NBAV).
Methods. There were 19,786 patients with at least one ECHO. Of these 234 had a CBAV, (prevalence, 1.2%). Group 1 (n=258) comprised the CBAV. Group 2 was the NBAV, (N=5,843). Patients in the NBAV with a mean aortic gradient ≤5mmHg were excluded. The Group 1. numbers are higher as a patient could progress from mild to moderate or moderate to severe AVS over the 14 years of data collection. The two groups were sub-divided into, mild, moderate or severe based on mean aortic valve gradient (AVG) according to the ASE guidelines. The AscAo measurement was taken from the 2D images. ANOVA and Tukey-Kramer testing or a t-test was performed when appropriate.
Results. The CBAV there show a statistically significant difference with ANOVA in the AscAo as the AVG Progressed. Tukey-Kramer testing indicated this was only between mild and moderate AVS. In the NBAV there was a progressive increase in the diameter of the ascending aorta which was also statistically significant. Similarly, Tukey-Kramer testing showed this was only significant between mild and moderate AVS. There were significant differences in the AscAo measurements between the CBAV and the NBAV for all severity grades. Those with NBAV are significantly older, see Table 1.
Conclusions. For both CBAV and NBAV dilatation of the AscAo occurs when the AVG is mild to moderate, further increase in severity of AVG has no influence on the AscAo measurement. The pathology of the aortopathy is cystic medial necrosis in the younger CBAV and atherosclerosis in the older NBAV group. The rates of progression of AscAo dilatation are similar for both groups, however patients with CBAV start off with a significantly larger AscAo diameter.
Table 1.
  Gp1. Bicuspid AS. Gp 2. Non-bicuspid AS.
AS N Age AVG AscAo N Age AVG AscAo
Mild (6-19mmHg) 196 47.0±15.1 8.6±4.3 35.6±6.3 5051 65.6±16.2 8.4±3.2 32.6±4.7
Mod (20-40mmHg) 46 56.8±11.5 27.1±6.7 38.1±7.2 610 74.3±10.4 26.3±5.6 34.1±4.6
Severe (>40mmHg) 16 58.8±8.7 52.8±10.2 39.1±3.8 182 75.9±10.0 52.8±10.7 34.4±5.3
ANOVA 258 <0.0001 <0.0001 <0.01 5843 <0.0001 <0.0001 <0.0001
AVG = mean aortic valve gradient (mmHg). AscAo = ascending aorta (mm). AS = aortic stenosis.