Morphological Assessment Of Aortic Root In Bicuspid Aortic Valve By Echocardiogram

Objective:The morphological parameters of aortic root(aortic annulus,Valsalva sinus,sinus junction and proximal ascending aorta)in patients with BAV stenosis were measured by transthoracic echocardiography.The data were analyzed in the following ways:Firstly,the data were compared to the morphological parameters of the aorta root in the patients with normal tricuspid,aortic valve(TAV)stenosis that matched the baseline characteristics of BAV group,to reveal the aortic root morphological characteristic of patients with BAV stenosis.Secondly,the aortic root morphological parameters of the subtype of BAV were compared to each other to explore the differences among the subtypes.Thirdly,all the subjects in BAV group were follow-up six monther once they were diagnosed BAV by echo,to exploe the experiences in clinical decision-making and procedures of different degree damage of aortic root in patients with BAV stenosis.This study was intended to evaluate the degree of lesion of each segment of the aorta in patients with BAV stenosis,and to provide the comprehensive and objective imaging information to the clinic in pre-operative evaluation,personaized procedure selection,prognosis predicition in patients with BAV stenosis.Methods:1.The morphological parameters,clinical procedure and short-term curative effect of aorta in 41 patients(29 males)with BAV stenosis confirmed in our hospital from May 8,2014 to September 30,2016 were analyzed by prospective study.The subjects in BAV group were divided into four subgroups(Fusion of the right and left coronary cusps,fusion of the right and noncoronary cusps,fusion of the right and noncoronary cusps and double-sinus with systematic two-leaflets type)according to anatomical characteristics.Another forty-one patients with normal developed TAV stenosis that matched the baseline(aortic stenosis,age,sex,heart function,blood pressure and body surface area)of BAV group were used as controls during the study peroid.2.Transthoracic echocardiography was performed on each subject.The following sonographic planes were neccessary for the measurement:the four-chamber view,the five-chamber view,the short axis of aortic artery view,the long-axis of left ventricule view,long-axis of the ascending aorta.The relavant parameters inlcuded the following:The number and anatomical arrangement of aortic leaflets,The maximum diameter and area of aortic annulus,Valsalva sinus,the sinus tube junction,and the proximal segment of the ascending aorta.The interventricular septum thickness,the maximum end-diastolic diameter of left ventricle and left ventricular ejection fraction.Results:1.The mean age of the BAV group was relatively lower than that of the TAV group(P<0.01).Explosured in the same risk factors(smoking history,diabetes mellitus,hyperlipidemia and hypertension).The percentage of AS in patients with BAV was 41%,AS and AR 59%.The degree of aortic stenosis in BAV group was positively correlated with age and body surface area(P<0.01).2.The diameter and area of the BAV group in the aortic valve,Valsalva sinus,sinus junction and ascending aorta were significantly higher than those in the TAV group(P<0.01).3.The wall expansion direction of the proximal ascending aorta in the BAV group follow certain patterns:RL type to the(rightward)anterior,RN type to the(rightward)posterior,LN type to the front,and double sinus with double leafleat type expanded mostly symmetrically.The diameter and area of ascending aorta in RN type were slightly larger than that of the RL type(P<0.01),but no significant differences were indentified at the levels of aortic annulus,Valsalva sinus and sinus junction.4.All the BAV patients were followed up for 6 months after they were diagnosed.In the BAV group,eighteen cases had no obvious clinical symptoms and kept watching closely,two were acute aortic dissection,one endocarditis,and the rest nine cases were lost to follow-up.Eleven patients underwent surgical treatment,seven were performed aortic root replacement and bilateral coronary artery open transplant(Bentall procedure),one with aortic valve and proximal ascending aorta replacement(Wheat procedure),and three with aortic valve replacement.One died of coronary anastomotic leakage one month later after Bentall procedure.Conclusion:1.The maximal diameter and area of aortic annulus,Vasalva sinus,sinus junction and proximal ascending aorta in BAV were significantly larger than those in TAV group.2.The wall expansion directionts of proximal ascending aorta follow certain patterns in BAV subtypes.The diameter of proximal ascending aorta of RN type was larger than RL type,but no significant differences were indentified at the levels of aortic annulus,Valsalva sinus and sinus junction.3.Various of clinical management options could be used for clinical management of BAV stenosis.An personalized strategy would be heloful in improving the outcomes.4.Transthoracic echocardiography can be used to analyze the morphological characteristics of the aorta and ascending aorta in patients with BAV,and provide comprehensive imaging data support for the clinical selection to achieve the best outcomes.