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The mechanics beyond bicuspid aortic valve
Session:
Painel 10 - Doença Valvular 10
Speaker:
André Azul Freitas
Congress:
CPC 2020
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.1 Valvular Heart Disease – Pathophysiology and Mechanisms
Session Type:
Posters
FP Number:
---
Authors:
André Azul Freitas; Patrícia M. Alves; James Milner; João André Ferreira; Cátia Santos Ferreira; Valdirene Gonçalves; José Paulo Almeida; Sofia S. Martinho; Elisabete Jorge; Lino Gonçalves
Abstract
<p><strong>Introduction:</strong> Bicuspid aortic valve (BAV) disease is the most common congenital cardiac defect and it is frequently associated with dilatation of the proximal ascending aorta. However, little is known about mechanics of the aortic root. In this study we aimed to evaluate aortic deformation in patients with BAV.</p> <p><strong>Methods:</strong> We conducted a retrospective observational study including 50 patients with BAV and 20 healthy controls. Echocardiographic evaluation included aortic valve planimetry, ascending aortic diameter, deformation of ascending aorta with longitudinal strain by speckle tracking echocardiography (STE) in parasternal long-axis view and deformation of aortic annulus with circumferential strain STE in parasternal short-axis view. Besides that, a complete assessment of aortic stenosis or regurgitation was made.</p> <p><strong>Results:</strong> Mean age was 42.4 ± 15.5 years with a male preponderance (74.3%). The BAV group was older (46.2 vs 33 years, p= 0.041), had higher aortic valve area (2.44 vs 2.14 cm², p=0.04), had a larger ascending aorta (40.5 vs 28.9 mm, p<0.001) and increased longitudinal aortic deformation (28.9 vs 17.7%, p=0.018). Circumferential deformation of the aortic annulus did not differ between groups (10.6 vs 9.7% p=0.58). Compared to controls, BAV patients with normal ascending aortic calibre (under 36 mm) showed an increased longitudinal strain (38.8 vs 17.5%, p=0.007). Among BAV patients, 16% had severe aortic regurgitation (AR) and 4% had severe aortic stenosis (AS). Besides aortic valve area, severe AR was associated with a higher longitudinal strain (45.2 vs 23.4%, p=0.002) and severe AS with a higher circumferential strain (21.6 vs 10%, p=0.004), with no significant differences in the other variables.</p> <p><strong>Conclusion:</strong> BAV is associated with an increase in longitudinal deformation of ascending aorta, particularly in severe AR patients. Longitudinal strain of the ascending aorta is increased even in patients with normal aortic diameter and may become a potential evaluation method of BAV, particularly detecting early disease involvement.</p>
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