Asociación entre la morfología de la válvula aórtica bicúspide y de la aorta ascendente / Association Between Bicuspid Aortic Valve and Ascending Aorta Morphology

RESUMEN Introducción: La válvula aórtica bicúspide (VAB) aparece en el 2% de la población y se divide en 3 grupos morfológicos: fusión de cúspide coronaria derecha e izquierda (DI), fusión de cúspide coronaria derecha y no coronaria (DN) y fusión de cúspide izquierda y no coronaria (NI). Objetivo: Evaluar la asociación entre la morfología de la válvula aórtica bicúspide con la morfología de la aorta ascendente. Material y métodos: Estudio descriptivo-analítico realizado en 200 pacientes. Las variables y los hallazgos ecocardiográficos se recogieron en un cuestionario. SPSS.22 se usó para el análisis estadístico. Resultados: Este estudio incluyó 139 (69,5%) hombres y 61 (30,5%) mujeres. La fusión de cúspide coronaria derecha e izquierda (69%) fue la morfología más habitual. La dilatación total de la aorta ascendente fue la morfología más común (44,5%). Conclusión: La morfología de fusión de cúspide coronaria derecha e izquierda fue la más común. La dilatación total de la aorta y la afectación funcional de la válvula aórtica fueron más comunes en la DI.

ABSTRACT Background: Bicuspid aortic valve (BAV) occurs in 2% of the population, and is divided into 3 morphological groups: right and left coronary cusp (RL), right coronary and non-coronary cusp (RN), and left coronary and non-coronary cusp (LN) fusion patterns. Objective: The aim of the study was to evaluate the association between bicuspid aortic valve morphology and ascending aorta morphology. Methods: This was a descriptive-analytical study carried out in 200 patients. A questionnaire collected echocardiographic findings and variables. SPSS 22 was used for statistical analysis. Results: The study enrolled 139 men (69.5%) and 61 women (30.5%). Right and left coronary cusp fusion (69%) and total dilation of the ascending aorta (44.5%) were the most common morphologies. Conclusion: Right and left coronary cusp fusion was the most prevalent morphology and total dilation of the aorta and abnormal aortic valve function were more frequent in RL cusp fusion.

Should sinus of valsalva be replaced in patients with dilated ascending aorta and aortic valve diseases?

Abstract Introduction: The aim of this study is to investigate the change in the dimension of sinus of Valsalva in patients who underwent supracoronary ascending aorta replacement with aortic valve replacement. Methods: A total of 81 patients who underwent supracoronary ascending aorta replacement with aortic valve replacement were included. Ten of 81 patients died during the follow-up. The patients were divided into three groups according to the aortic valve diseases. Group I (n=17) included patients with bicuspid valves, group II (n=30) included patients with stenotic degenerative valves, and patients with aortic regurgitation constituted group III (n=24). In preoperative and follow-up periods, the sinus of Valsalva diameter of the patients was evaluated by echocardiographic examination. The mean age was 54.1±15.1 years. Twenty-eight (34.6%) patients were female and 12 (14.8%) patients were in New York Heart Association functional class III. Results: There was no early mortality. Late mortality was developed in 10 (12.4%) patients, 8 (9.9%) due to non-cardiac reasons. Late follow-up was obtained in 71 patients with a mean of 60±30.1 months postoperatively. During follow-up, the increase in the diameter of the sinus of Valsalva was significant in Group I (P<0.01), while in Group II and III it was insignificant (P>0.05). Conclusion: To avoid the risks associated with sinus of Valsalva dilatation, it is reasonable to replace the sinus of Valsalva in the setting of aortic valve replacement and ascending aorta replacement for bicuspid aortic valve with a dilated ascending aorta and relatively normal sinuses of Valsalva in young patients.

Tratamento cirúrgico da raiz da aorta: é possível preservar a valva aórtica? / Surgical treatment of the aortic root, is it possible to preserve the aortic valve

O tratamento cirúrgico convencional para os pacientes portadores de aneurisma da raiz da aorta é a sua substituição completa por um conduto valvulado associado ao reimplante dos óstios coronários. Este é um procedimento de baixo risco, duradouro e principalmente utilizado naqueles pacientes que se recusam a imaginar a necessidade de outra operação, apesar da necessidade de utilização do anticoagulante oral em definitivo. Alternativamente, é possível a reconstrução deste seguimento da aorta com preservação valvar. Muita controvérsia existe em relação à longevidade deste complexo tratamento alternativo, apesar dos resultados imediatos, em muitas séries, melhores até que os obtidos com a operação convencional. A literatura sugere que a síndrome de Marfan, a valva aórtica bivalvulada, os grandes aneurismas, os anéis aórticos dilatados, a ausência de fixação do anel aórtico e a necessidade de plastia de um ou mais folhetos aórticos sejam os principais preditores de reoperação no seguinte tardio dos pacientes que tiveram a valva aórtica preservada...

The conventional surgical treatment for patients with aortic root aneurysm has been the replacement of the entire root and valve with a composite valve graft and the reimplantation of the coronary ostium. It has become a low risk operation although its effects are long-standing. It is usually used in patients who do not wish to accept the risk of another operation, despite the indefinite anticoagulation needs. Alternatively, the valve sparing aortic operation is a practical possibility. Despite its immediate results in many series, even better by those obtained by a conventional operation, the longetivity of this complex alternative treatment is still controversial. Many papers suggest that Marfan syndrome, bicuspid aortic valve, large aneurysms, large aortic rings, the absence of aortic ring fixation and the need of aortic leaflets plasty are predictors of reoperation during the follow up. There is no doubt, however, that the aortic root reconstruction can be performed with low hospital mortality and high freedom from aortic valve-related reoperation, however the choice of the best procedure must be individualized for each patient and the valve sparing operation it is neither a procedure that can be performed by all surgeons nor applied to all patients.