Thorac Cardiovasc Surg 2007; 55(8): 485-490
DOI: 10.1055/s-2007-965387
Original Cardiovascular

© Georg Thieme Verlag KG Stuttgart · New York

Differences in Clinical Manifestations in Patients with Bicuspid and Tricuspid Aortic Valves Undergoing Surgery of the Aortic Valve and/or Ascending Aorta

M. Bauer1 , U. Bauer2 , H. Siniawski1 , R. Hetzer1
  • 1Department of Cardiothoracic Surgery, DHZB, Berlin, Germany
  • 2Department of Pediatric Cardiology, DHZB, Berlin, Germany
Further Information

Publication History

received January 27, 2007

Publication Date:
19 November 2007 (online)

Abstract

A bicuspid aortic valve is found in approximately 2 % of the population. The data in the literature concerning the incidence of clinical manifestations are inconsistent, and a detailed comparison with patients with tricuspid aortic valve is not yet available. We analyzed the clinical manifestations and demographic data of patients with bicuspid and tricuspid aortic valves who underwent an operation on the aortic valve and/or the ascending aorta over a five-year period. The subjects were 2570 adult patients, of whom 555 (21.6 %) had a bicuspid aortic valve. The patients with a bicuspid aortic valve were, on average, 10 years younger at surgery than those with a tricuspid aortic valve (57.0 ± 13.1 vs. 66.4 ± 11.8 years, p < 0.0001). The spectrum of diseases necessitating aortic valve surgery was the same in both groups of patients. An increased diameter of the ascending aorta ≥ 4.5 cm was seen significantly more often in patients with bicuspid aortic valve (22.7 % vs. 5.5 %, p < 0.0001). We conclude that there are important differences in clinical manifestations between patients with bicuspid and tricuspid aortic valves, so that patients with bicuspid valve need special attention.

References

  • 1 Roberts W C. The congenitally bicuspid aortic valve: a study of 85 autopsy cases.  Am J Cardiol. 1970;  26 72-83
  • 2 Boudoulas H, Vavuranakis M, Wooley C F. Valvular heart valve disease: the influence of changing etiology on nosology.  J Heart Valve Dis. 1994;  3 516-526
  • 3 Fenoglio J J, McAllister H A, DeCastro C M, Davia J E, Cheitlin M D. Congenital bicuspid aortic valve after age 20.  Am J Cardiol. 1977;  39 164-169
  • 4 Yotsumoto G, Moriyama Y, Toyohira H, Shimokawa S, Iguro Y, Watanabe S, Masuda H, Hisatomi K, Taira A. Congenital bicuspid aortic valve: analysis of 63 surgical cases.  J Heart Valve Dis. 1998;  7 500-503
  • 5 Ando M, Okita Y, Morota T, Takamoto S. Thoracic aortic aneurysm associated with congenital bicuspid aortic valve.  Cardiovasc Surg. 1998;  6 629-634
  • 6 Abbott M E. Coarctation of the aorta of the adult type.  Am Heart J. 1928;  3 574-618
  • 7 Mills P, Leech G, Davies M, Leatham A. The natural history of a non-stenotic bicuspid aortic valve.  Br Heart J. 1978;  40 951-957
  • 8 Kappetein A P, Gittenberger-de Groot A C, Zwinderman A H, Rohmer J, Poelmann R E, Huysmans H A. The neural crest as a possible pathogenetic factor in coarctation of the aorta and bicuspid aortic valve.  J Thorac Cardiovasc Surg. 1991;  102 830-836
  • 9 Beppu S, Suzuki S, Matsuda H, Ohmori F, Nagata S, Miyatake K. Rapidity of progression of aortic stenosis in patients with congenital bicuspid aortic valves.  Am J Cardiol. 1993;  71 322-327
  • 10 Turina J, Turina M, Krayenbühl H P. Die Bedeutung der bikuspiden Aortenklappen für die Entstehung des Aortenklappenvitiums bei Erwachsenen.  Schweiz Med Wschr. 1986;  116 1518-1523
  • 11 Duran A C, Frescura C, Sans-Coma V, Angelini A, Basso C, Thiene G. Bicuspid aortic valves in hearts with other congenital heart disease.  J Heart Valve Dis. 1995;  4 581-590
  • 12 Reifenstein G H, Levine S A, Gross R E. Coarctation of the aorta: a review of 104 autopsied cases of the adult type, 2 years of age or older.  Am Heart J. 1947;  33 146-168
  • 13 Becker A E, Becker M J, Edwards J E. Anomalies associated with coarctation of the aorta: particular reference to infancy.  Circulation. 1970;  41 1067-1075
  • 14 Larson E W, Edwards W D. Risk factors for aortic dissection: a necropsy study of 161 cases.  Am J Cardiol. 1984;  53 849-855
  • 15 Scharhag J, Meyer T, Kindermann I, Schneider G, Urhausen A, Kindermann W. Bicuspid aortic valve.  Clin Res Cardiol. 2006;  95 228-234
  • 16 Sadee A S, Becker A E, Verheul J A. The congenital bicuspid aortic valve with post-inflammatory disease - a neglected pathological diagnosis of clinical relevance.  Eur Heart J. 1994;  15 503-506
  • 17 Pachulski R T, Chan K L. Progression of aortic valve dysfunction in 51 adult patients with congenital bicuspid aortic valve: assessment and follow-up by Doppler echocardiography.  Br Heart J. 1993;  69 237-240
  • 18 Roman M J, Devereux R B, Kramer-Fox R, O'Loughlin J, Spitzer M, Robins J. Two-dimensional echocardiographic aortic root dimensions in normal children and adults.  Am J Cardiol. 1989;  64 507-512
  • 19 Burks J M, Illes R W, Keating E C, Lubbe W J. Ascending aortic aneurysm and dissection in young adults with bicuspid aortic valve: implications for echocardiographic surveillance.  Clin Cardiol. 1998;  21 439-443

Dr. PD Matthias Bauer

Department of Cardiothoracic Surgery
Deutsches Herzzentrum Berlin

Augustenburger Platz 1

13353 Berlin

Germany

Phone: + 49 30 45 93 22 61

Fax: + 49 30 45 93 10 03

Email: mbauer@dhzb.de

    >