Relationship Between Coronary Artery Anomalies And Bicuspid Aortic Valve Disease
Shiho Naito, Johannes Petersen, Niklas Neumann, Tatiana Sequeira Gross, Yskert von Kodolitsch, Hermann Reichenspurner, Evaldas Girdauskas.
University Heart Center Hamburg, Hamburg, Germany.
OBJECTIVE: The knowledge of specific coronary circulation pattern has a major clinical impact, affecting not only conventional surgical procedures but also the new evolving technologies, like transcatheter aortic valve replacement (TAVR). The association of anomalous anatomy of coronary arteries and congenital bicuspid aortic valve (BAV) has been sporadically reported. Our aim was to evaluate the prevalence of coronary anomalies between BAV and tricuspid aortic valve morphology (TAV).
METHODS: A total of 1097 consecutive patients who received preoperative coronary evaluation and elective aortic valve replacement or repair between January, 2013 and July, 2016 at our institution were involved. Based on the surgical inspection at the open-heart surgery, a total of 344 patients (31%) were diagnosed with BAV, including 14 monocuspid patients (1%), whereas the remaining 753 patients (68%) had TAV. Coronary anatomy was evaluated by preoperative coronary angiography (n=1082) or multi-slice computed tomography (n=15).
RESULTS: A total of 193 (18%) coronary anomalies were detected (BAV vs TAV; 23% vs 15 %, p=0.002) ;left dominant coronary systems (18% vs 12 %, p=0.010), separate left anterior descending artery(LAD) and left circumflex artery(LCX) (2% vs 1 %, p=0.079), anomalous origin of right coronary artery (RCA)(4% vs 2%, p=0.082), anomalous origin of left coronary artery(1% vs 1%, p=0.511) . Subgroup analysis revealed significant relations between coronary anomaly and BAV (p=0.007) or connective tissue disease(p<0.0001). There was no significant relation between coronary anomaly an aortic phenotype(tubular, arch, root; p=0.361, 0.804, 0.315, respectively) or valve pathology (stenosis, insufficiency; p=0.432, 0.439, respectively).
CONCLUSIONS: Our study revealed a significantly increased prevalence of coronary anomalies in BAV patients.
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