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Aortic Root Geometry In Patients With A Unicuspid Aortic Valve Disease: Comparison With A Bicuspid And Tricuspid Aortic Valve Entity
Shiho Naito, Hermann Reichenspurner, Evaldas Girdauskas.
University Heart Center Hamburg, Hamburg, Germany.

OBJECTIVE: Patients with a unicuspid aortic valve (UAV) may represent a unique clinical entity which differs significantly from that of bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) disorders. Herein, we aimed to assess the geometric and clinical characteristics of patients presenting with UAV as compared to those with a BAV and TAV morphology.
METHODS: A total of consecutive 122 patients between 15 and 45 years who were referred for aortic valve surgery (i.e. replacement or repair) and underwent preoperative MDCT between 2011 and 2017, were retrospectively analyzed. All patients > 45 years underwent routinely a preoperative coronary angiography and therefore were systematically excluded. A total of 11 patients were diagnosed with UAV and 67 patients were diagnosed with BAV, whereas the remaining 44 patients had TAV. MDCT-based aortic root diameters were subsequently compared between UAV, BAV and TAV patients. Calcification grades were assessed by preoperative CT Scan as well as intraoperatively by the attending surgeon. The severity of AV calcification was quantified according to the previously established guidelines.
RESULTS:The UAV patients had significantly more aortic stenosis as compared to their BAV and TAV counterparts (p=0.012). This finding correlate well with the higher prevalence of AV cusp calcification in the UAV cohort, especially in comparison with the TAV cohort (p=0.007). Furthermore, UAV patients showed a tendency towards larger AV annulus and ascending aortic diameters as compared to their BAV/TAV counterparts.
CONCLUSIONS: Although aortic root geometry was not significantly different among UAV, BAV, and TAV patients, our study revealed a tendency towards more calcification and more stenotic changes in patients with a UAV disease (UAV>BAV>TAV). Our finding could suggest that more severe transvalvular disturbances in UAV patients may result faster and more extensive UAV degeneration as compared to the BAV and TAV entities.


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