Matrix metalloproteinases in ascending aortic aneurysms: Bicuspid versus trileaflet aortic valves1
Scott A. LeMaireXinwen WangJonathan A. WilksStacey A. CarterShixiang WenTaehee WonDominic LeonardelliGobind AnandLori D. ConklinXing Li WangRobert W. ThompsonJoseph S. Coselli
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Objective To determine whether the ascending aortic dilation associated with a bicuspid aortic valve occurs independently of valvular hemodynamic abnormality. Methods Aortic dimensions were measured by two echocardiography in 79 subjects with a functionally normal ( n =42) or stenotic ( n =37) bicuspid aortic valve and compared with the findings in 40 normal subjects matched for age, body surface area and artery pressure. Ascending aortic measurements were made at four levels: annulus, sinuses of Valsalva, supra aortic ridge, and proximal ascending aorta. Results The dimensions of the ascending aorta in subjects with a bicuspid aortic valve were larger than in controls at three levels:sinuses of Valsalva, supra aortic ridge, and proximal ascending aorta ( P 0.05 to P 0.001). There were 18 subjects had ascending aortic dimensions comparable with controls, while 24 had definitely abnormal ascending aortic dimensions in 42 subjects with a functionally normal bicuspid aortic valve. Conclusion There was a high prevalence of ascending aortic dilatation in patients with bicuspid aortic valve. These findings support the hypothesis that bicuspid aortic valve and ascending aortic dilation may reflect a common developmental defect.
Cardiac skeleton
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Adventitia
Abdominal aorta
Surgical oncology
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Objectives: To explore the difference in ascending aortic dilatation between subgroups of bicuspid aortic valve (BAV) patients with and without coarctation of the aorta (CoA). Methods: Our echocardiographic database (1993–2006) was searched for BAV patients with CoA (Group A) and without CoA (Group B). Measurements at the aortic annulus, root, sinotubular junction, and ascending aorta were obtained for each patient, and body surface area-adjusted Z-score values were compared. Exclusion criteria included more than mild aortic stenosis or regurgitation, previous balloon aortic valvuloplasty, or complex left heart disease; plus Turner, Noonan, Williams, and Marfan Syndromes. Results: The median age in Group A (n=53) was 11.3 yrs (range 0 to 30) with median follow-up of 7 yrs (0 to 12.7); median age in Group B (n=145) was 8.7 yrs (0 to 29) with median follow-up of 4 yrs (0 to 13.1). Group B patients had significantly greater aortic annulus, sinotubular junction, and ascending aortic dimensions (ascending aorta Z-scores shown in Figure , p<0.0001). Group A ascending aortic dimensions did not differ significantly from the normal population. The rate of growth of the ascending aorta in Group B was higher in the first 10 years of life. Conclusion: The ascending aorta in patients with bicuspid aortic valve and coarctation does not dilate to the same degree as patients with isolated bicuspid aortic valve. This may reflect an inherent difference in aortic wall properties between the two groups. Comparison of Ascending Aorta Z Scores
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Objectives: Bicuspid aortic valves (BAV) are frequently associated with root/ascending aorta (AA) dilation, but there is controversy regarding when to operate to prevent dissection of a dilated aorta associated with a well-functioning BAV.
Dilation (metric space)
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Objective To investigate whether alpha-1 antitrypsin is present in normal human aorta, ascending aortic aneurysm and stanford A type aortic dissection (TAAD) tissues and whether there are some expression differences in alpha-1 antitrypsin levels among them, and discuss its potential protective effects on aortic wall structure. Methods Histological method, semi-quantified reverse transcription polymerase chain reaction (RT-PCR) and Western blotting were used to test whether alpha-1 antitrypsin was present in normal human aorta, ascending aortic aneurysm and TAAD tissues. TAAD tissues in 14 cases, ascending aortic aneurysm tissues in 7 cases and normal ascending aorta tissues in 7 cases were harvested. Results alpha-1 antitrypsin expression was strongly increased in TAAD and ascending aortic aneurysm tissues as compared with normal aorta (0. 285 ±0. 010, 0. 153 ±0. 011,0. 102 ±0. 010,P <0. 05). alpha-1 antitrypsin was increased more significantly in ascending aortic aneurysm than in TAAD (0. 285 ±0. 010 vs 0. 153 ±0. 011 ,P < 0. 05 ). RT-PCR revealed that there was endogenous alpha-1 antitrypsin produced in aortic wall, and mRNA expression levels of them were highest in ascending aortic aneurym and lowest in TAAD (2. 192 ±0. 133, 1. 213 ±0. 156, 0. 672 ±0. 101 ,P <0. 05). Conclusion alpha-1 antitrypsin is present in normal human aorta, ascending aortic aneurysm and TAAD tissues, and there are differential expression differences among them. alpha-1 antitrypsin presents a potential pathway for protection of aortic wall structure.
Key words:
Antitrypsin; Aneurysm; Ascending aorta
Alpha (finance)
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Aortoventricular Tunnel With Severely Dilated Ascending Aorta and Bicuspid Aortic Valve in a Newborn
Aortoventricular tunnel is a rare congenital cardiovascular malformation whereby there is a paravalvular communication between the aorta and a ventricle. This unique case describes a newborn with an aortoventricular tunnel, a severely dilated ascending aorta, and a bicuspid aortic valve, which was suspected prenatally and surgically managed postnatally. (Level of Difficulty: Intermediate.).
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Bicuspid aortic valve (BAV) can be both sporadic and hereditary, is phenotypically variable, and genetically heterogeneous. The clinical presentation of BAV is diverse and commonly associated with a high prevalence of valvular dysfunction producing altered hemodynamics and aortic abnormalities (e.g., aneurysm and dissection). The thoracic aortic aneurysm in BAV frequently involves the proximal aorta, including the aortic root, ascending aorta, and aortic arch, but spares the aorta distal to the aortic arch. While the ascending aortic aneurysm might be affected by both aortopathy and hemodynamics, the aortic root aneurysm is considered to be more of a consequence of aortopathy rather than hemodynamics, especially in younger patients. The management of aortic aneurysm in BAV has been very controversial because the molecular mechanism is unknown. Increasing evidence points toward the BAV root phenotype (aortic root dilation with aortic insufficiency) as having a higher risk of catastrophic aortic complications. We propose more aggressive surgical approaches toward the BAV with root phenotype.
Thoracic aortic aneurysm
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Objectives: To describe the incidence and rate of dilatation of the ascending aorta in children with bicuspid aortic valve (BAV) and to determine factors that predict rapid aortic dilatation. Design: Retrospective cohort study. Setting: Regional tertiary care children’s hospital. Patients: All children aged 0–18 years seen at the authors’ institution between 1990 and 2003 with an “isolated” BAV. All patients had had more than one technically adequate echocardiogram, at least six months apart, with concomitant height and weight data. Interventions: Offline echocardiographic measurements of multiple levels of the aortic root were completed for each participant at each serial echocardiogram. These measurements were then compared with expected measurements derived from a normal local control population. Main outcome measures: Rate of change of the ascending aorta size over time, where aortic size is expressed as the number of standard deviations above or below the mean size expected for a given body surface area (z score). Results: 279 echocardiograms spanning a period of from 9 months to 13.3 years were analysed for 88 patients with BAV. The ascending aorta in the BAV group was larger than expected for body surface area at diagnosis and continued to increase in relative size at each of the four subsequent follow-up echocardiograms. Ascending aortic z score increased at an average rate of 0.4/year. A faster rate of increase in z score was predicted by both larger initial aortic valve gradient and non-use of β blockers. Conclusions: Children with BAV are at risk of having a dilated ascending aorta. This risk increases with longer follow up.
Body surface area
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Objective To investigate the morphology and the cause of the ascending aortic aneurysm induced by ascending aorta banding. Methods Forty young Wistar rats were divided into two groups:the control group (10 rats) and the experiment group (30 rats).The rat models induced by ascending aorta banding were made.The ascending aortas were taken after operation in 3-5 months,and special staining and immuohistochemical staining technique were performed and observed under light microscope. Results The ascending aortic aneurysms were induced by ascending aorta banding of the young Wistar rats 3-5 months after operation.The occurrence of the aneurysm is 63.3%,and the occurrence of dissecting aneurysms is 36.7%.The expression of MMP-2 and MMP-3 is strong in the ascending aortic aneurysm.Conclusion The occurrence of ascending aortic induced by banding ascending aorta of the young Wistar rat is high,and the expression of MMP-2 and MMP-3 is strong.
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