Francis Robicsek1, Jeko M Madjarov1, Robert F Padera2. 1. Department of Thoracic and Cardiovascular Surgery, Sanger Heart and Vascular Institute, Carolinas Medical Centre, Charlotte, North Carolina, United States. 2. Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, United States.
Abstract
BACKGROUND: This article discusses about the cause of dilatation of the ascending aorta in patients with congenitally bicuspid aortic valves (CBAVs). Some members of the profession believe that it is genetic, while others attribute it to turbulence. The author previously presented in vitro data proving that CBAVs are inherently morphological stenotic, even in the absence of measurable gradient and clinical symptoms. This article reinforces the view that the dilatation of the ascending aorta in patients with CBAV represents a "poststenotic dilatation" by demonstrating that the structure of the aortic wall is normal in infants who have CBAV as a sole cardiac anomaly. METHODS: The aortic wall was studied in newborns who had CBAV as the sole cardiovascular anomaly and in those where CABV was associated with other inborn cardiovascular defects. RESULTS: We found that in patients where CBAV is the sole cardiovascular anomaly, aortic structure is normal at birth, but abnormal if additional cardiovascular anomalies are present. CONCLUSIONS: Dilatation of the ascending aorta in patients, where CBAV is the only cardiovascular anomaly, is caused by turbulence (poststenotic dilatation). If additional cardiovascular anomalies are present, this process may be exaggerated by genetic abnormalities of the aortic wall. Georg Thieme Verlag KG Stuttgart · New York.
BACKGROUND: This article discusses about the cause of dilatation of the ascending aorta in patients with congenitally bicuspid aortic valves (CBAVs). Some members of the profession believe that it is genetic, while others attribute it to turbulence. The author previously presented in vitro data proving that CBAVs are inherently morphological stenotic, even in the absence of measurable gradient and clinical symptoms. This article reinforces the view that the dilatation of the ascending aorta in patients with CBAV represents a "poststenotic dilatation" by demonstrating that the structure of the aortic wall is normal in infants who have CBAV as a sole cardiac anomaly. METHODS: The aortic wall was studied in newborns who had CBAV as the sole cardiovascular anomaly and in those where CABV was associated with other inborn cardiovascular defects. RESULTS: We found that in patients where CBAV is the sole cardiovascular anomaly, aortic structure is normal at birth, but abnormal if additional cardiovascular anomalies are present. CONCLUSIONS: Dilatation of the ascending aorta in patients, where CBAV is the only cardiovascular anomaly, is caused by turbulence (poststenotic dilatation). If additional cardiovascular anomalies are present, this process may be exaggerated by genetic abnormalities of the aortic wall. Georg Thieme Verlag KG Stuttgart · New York.
Authors: Maria von Stumm; Tatjana Sequeira-Gross; Johannes Petersen; Shiho Naito; Lisa Müller; Christoph Sinning; Evaldas Girdauskas Journal: Cardiovasc Diagn Ther Date: 2021-04
Authors: Jeko M Madjarov; Michael G Katz; Sarah M Gubara; Svetozar Madzharov; Kevin Reames; Sophia Madjarova; Francis Robicsek Journal: J Cardiothorac Surg Date: 2019-06-26 Impact factor: 1.637