ObjectiveTo assess clinical results of aortic cusps replacement with bovine pericardium for bicuspid aortic valve (BAV) and severe aortic regurgitation (AR). MethodsClinical data of 79 patients with BAV and severe AR who underwent aortic cusps replacement with bovine pericardium in Wuhan Asia Heart Hospital from June 2008 to December 2013 were retrospectively analyzed. There were 60 male and 19 female patients with their age of 38±14 years (ranged 12-78 years). All the patients were in NYHA class Ⅱ. There were 26 patients with ascending aorta and sinotubular expanding. ResultsNo early death or major complication was recorded. Intraoperative transesophageal echocardiography showed successful repair with normal coaptation of the aortic leaflets in all the patients. AR grade was less than mild in all the patients with peak aortic valve pressure gradients of 14.2±2.8 mm Hg. All the patients were discharged from the hospital within 15 postoperative days without any adverse symptom, and were followed up for 50±16 months (ranged 9-64 months). During follow-up, all the patients were in NYHA classⅠ. There were 57 patients without AR, 16 patients with mild AR, 5 patients with moderate AR and 1 patients with severe AR. The peak of aortic valve pressure gradient was 12.4±3.2 mm Hg. The average diameter of ascending aorta was 2.7 cm in the patients with ascending aorta and sinotubular expanding. The shape of sinotubular kept normal. The height of coaptation of aortic valve was 0.58 cm by echocadiography. None of the patients died or required reoperation. The structural valve degeneration was not observed during the follow-up. ConclusionThree aortic cusps replacement with bovine pericardium can produce good hemodynamics and midterm results for patients with BAV and severe AR. The ascending aorta and sinotubular should be reduced and fixed in the patients with ascending aorta and sinotubular expanding.
ObjectiveTo summarize the characteristics of bicuspid aortic valve (BAV) aortopathy and analyze the association between aortopathy and BAV phenotype and patterns of valvular dysfunction.MethodsClinical data of 191 patients who underwent the first aortic valve replacement in Fuwai Hospital from June 2017 to March 2018 were retrospectively analyzed, including 143 males and 48 females with an average age of 53.91±12.52 years. All patients underwent multidetector computed tomography (MDCT) and echocardiography before the operation, excluding patients with aortic coarctation. The BAV aortopathy phenotype was classified during operation. The characteristics of BAV aortopathy were analyzed by cluster and artificial analysis. BAV anatomic phenotype was divided into two types according to the direction of valve opening: BAV-AP and BAV-LR.ResultsFour distinct BAV aortopathy phenotypes were identified: a common type (n=70, 36.6%), with no dilation or mild dilation of aorta; a root type (n=24, 12.6%), with predominant dilatation of aortic sinus; an ascending aorta type (n=72, 37.7%), with predominant dilatation of ascending aorta; an arch type (n=25, 13.1%), with predominant dilatation of aortic arch dilatation. The root type was mainly in young patients, while the arch type was mainly in elderly patients (P<0.05). BAV-AP and aortic insufficiency were most prevalent in root type, while BAV-LR and aortic stenosis were most prevalent in arch type (P<0.05). There were 111 (58.1%) patients undergoing aortic surgery, and the coincidence rate of BAV aortopathy phenotype and aortic surgery was 80.6%.ConclusionAccording to the location of aortic dilation, BAV aortopathy can be divided into four types. There is an association between BAV aortopathy and valvular phenotype and dysfunction.
ObjectiveTo analyze the clinical characteristics and surgical treatment of bicuspid aortic valve combined with thoracic aortic dilation. MethodsWe retrospectively analyzed the clinical data of 68 patients of bicuspid aortic valve combined with thoracic aortic dilation underwent surgical treatment in our hospital between January 2010 and June 2014. There were 47 males and 21 females at age of 26-77(44.5±16.3) years. Different surgical treatments including Wheat procedure(n=22), aortic valve replacement+ascending aortoplasty(n=10), Bentall procedure(n=13), aortic valve replacement+ascending aortic replacement+right hemi aortic arch replacement(n=13), Bentall procedure+ascending aortic replacement+right hemi aortic arch replacement(n=8), Bentall procedure+ascending aortic replacement+total arch replacement+stented elephant trunk(n=2) were carried out according to the type. ResultsAll 68 patients underwent surgical treatment. The mortality in hospital is at 4.4%(3/68). The postoperative complications were neurological and mental complications(n=3), pneumonia(n=2), and exploratory thoracotomy(n=2). We followed up 63 patients for 6 months to 4 years. A total of 62 patients were well without reoperation except one death at the end of following-up 2 years. ConclusionBicuspid aortic valve combined with thoracic aortic dilation has diversiform clinical characteristics. The surgical treatment should be chosen according to the aortic valve and thoracic aortic lesion characteristics.
ObjectiveTo summarize the clinical result of a combined technical system for bicuspid aortic valve (BAV) repair. MethodsPatients who diagnosed as BAV and sever aortic regurgitation (AR) underwent a strategy of combined repair technics including annuloplasty, sinus plasty, leaflet plasty, sinus-tubular junction (STJ) plasty depending on anatomy pathological characteristics between October 2019 and January 2021 were enrolled. The clinical data of the patients were analyzed.ResultsA total of 17 patients were enrolled. There were 11 males and 6 females with an average age of 18-49 (32.4±13.6) years. Fifteen patients had typeⅠand 2 patients had typeⅡBAV according to Sievers classification. Annuloplasty was applicated in 13 patients, sinus plasty in 8 patients, leaflet plasty in 17 patients, and STJ plasty in 11 patients, respectively. The cardiopulmonary bypass (CPB) time was 95 (84, 135) min, aortic cross-clamping time was 68 (57, 112) min, and the ICU stay time was 17 (12, 25) h. After the operation, mild AR was presented in 14 patients, moderate AR in 1 patient and severe AR in 2 patients. The latter 3 patients underwent second operation under CPB, after then, 1 patient had mild AR and 2 patients had moderate AR. The follow-up time was 13.1±4.6 months. At the latest follow-up, 12 patients had mild AR and 5 patients had moderate AR, and no patient had reoperation. ConclusionA combined technical system for BAV repair can be used effectively and safely with an acceptable short and middle-term result.
Due to the lack of calcification of the aortic valve, it is difficult to provide effective support for the fixation of artificial valve in aortic stenosis characterized by leaflet thickening. There is a risk of postoperative perivalvular leakage and secondary valve implantation, which is widely regarded as a relative contraindication for transcatheter aortic valve replacement (TAVR). But aortic valvuloplasty and self-expanding transcatheter aortic valve has showed its safety and efficacy. This paper reports a patient with bicuspid aortic valve characterized by leaflet thickening treated with TAVR. After the operation, the patient’s symptom of exertional dyspnea was significantly improved, New York Heart Association class increased to Ⅱ, no perivalvular leakage was found, and the mean transaortic pressure gradient and the maximum aortic valve velocity decreased significantly.
ObjectiveTo discuss the feasibility of establishment of animal model of "functional" bicuspid aortic valve with swine and observe its effect on the wall shear stress inside the aorta. MethodsFour common Shanghai White Swine with body weight between 50 kg to 55 kg were selected. Under general anesthesia and cardiopulmonary bypass, the aortic transverse incision approach was used, continuous suture with 6-0 polypropylene to align the left and right coronary valve leaflets to create a bicuspid valve morphology. After the operation, echocardiography was used to observe the aortic valve morphology and the hemodynamic changes of the aortic valve orifice. The effect on the wall shear stress inside the aorta was studied with 4D-Flow magnetic resonance imaging (MRI). ResultsA total of 4 swine "functional" bicuspid aortic valve models were established, with a success rate of 100.0%. Echocardiography showed that the blood flow velocity of the aortic valve orifice was faster than that before the operation (0.96 m/s vs. 1.80 m/s). 4D-Flow MRI showed abnormally increased wall shear stress and blood flow velocity in the aorta of the animal models. After the surgery, in model animals, the maximal wall shear stress inside the ascending aorta was greater than 1.36 Pa, and the maximum blood flow velocity was greater than 1.4 m/s. ConclusionEstablishment of the animal model of "functional" bicuspid aortic valve in swine is feasible, scientific and reliable. It can be used in researches on evaluating the pathophysiological changes.
Objective To explore the key genes, pathways and immune cell infiltration of bicuspid aortic valve (BAV) with ascending aortic dilation by bioinformatics analysis. Methods The data set GSE83675 was downloaded from the Gene Expression Omnibus database (up to May 12th, 2022). Differentially expressed genes (DEGs) were analyzed and gene set enrichment analysis (GSEA) was conducted using R language. STRING database and Cytoscape software were used to construct protein-protein interaction (PPI) network and identify hub genes. The proportion of immune cells infiltration was calculated by CIBERSORT deconvolution algorithm. Results There were 199 DEGs identified, including 19 up-regulated DEGs and 180 down-regulated DEGs. GSEA showed that the main enrichment pathways were cytokine-cytokine receptor interaction, pathways in cancer, regulation of actin cytoskeleton, chemokine signaling pathway and mitogen-activated protein kinase signaling pathway. Ten hub genes (EGFR, RIMS3, DLGAP2, RAPH1, CCNB3, CD3E, PIK3R5, TP73, PAK3, and AGAP2) were identified in PPI network. CIBERSORT analysis showed that activated natural killer cells were significantly higher in dilated aorta with BAV. Conclusions These identified key genes and pathways provide new insights into BAV aortopathy. Activated natural killer cells may participate in the dilation of ascending aorta with BAV.
Objective To evaluate the early clinical effect of reimplantation in the treatment of bicuspid aortic valve (BAV) with aortic root aneurysm. Methods The clinical data of 25 patients with BAV and aortic root aneurysm[mean diameter: 45-63 (52.68±5.55) mm] undergoing reimplantation in West China Hospital from November 2019 to May 2021 were retrospectively reviewed. There were 22 males and 3 females. The mean age was 15-65 (50.00±13.10) years and body surface area was 1.79±0.23 m2. ResultsThe pathological classification of BAV malformation was confirmed during the operation: Type 0 in 3 patients and Type 1 in 22 patients. There were 12 patients undergoing cusp central plication, and 2 patients were sutured with a closed fusion crest. Postoperative valve leaflet coaptation height was 0.78±0.15 cm, and effective height was 1.27±0.19 cm. In operation, maximum aortic valve flow velocity was 1.65±0.42 m/s, pressure difference was 5.46±3.05 mm Hg, and aortic valve annulus diameter was 21.32±0.95 mm. Cardiopulmonary bypass time was 225.84±35.34 min, and aortic block time was 189.60±26.51 min. In-hospital time was 11.64±3.07 d, ICU stay time was 2.64±0.99 d, and mechanical ventilation time was 1.48±0.87 d. The follow-up time was 17.20±4.70 months, and no death or major complications occurred during the follow-up in all patients. The cardiac function of the patients significantly improved postoperatively (P≤0.05). Echocardiography suggested that 12 patients had no aortic regurgitation, 10 minor aortic regurgitation, 3 mild aortic regurgitation, and no patients with moderate or more severe regurgitation. The diameter of the aortic sinus, left ventricular end-diastolic diameter and volume decreased during the follow-up, compared to preoperative ones (P≤0.05). The maximum flow velocity of the aortic valve was 1.54±0.36 m/s, and the pressure difference was 5.17±2.38 mm Hg during the follow-up. ConclusionReimplantation technology has a good clinical effect for highly selective BAV patients. It can effectively avoid long-term postoperative anticoagulation, but the maximum flow rate after surgery is slightly increased, which may be related to the configuration of BAV itself. While compared with valve replacement, the effect is still worthy of recognition.
Objective To investigate the impact of bicuspid aortic valve (BAV) on the rate of ascending aortic diameter re-dilation following ascending aorta remodeling. Methods A retrospective analysis was performed on the clinical data of patients who underwent aortic valve replacement (AVR) combined with ascending aorta remodeling at Fuwai Hospital between 2010 and 2022. The rate of ascending aortic diameter re-dilation after remodeling was calculated and compared between patients with tricuspid aortic valve (TAV) and BAV within the longitudinal aortotomy-sandwich technique and external wrapping technique groups. We explored whether BAV affects the rate of diameter re-dilation after remodeling. Results A total of 84 patients were included, comprising 58 males and 26 females, with a mean age of (54.30±11.36) years (range: 22-76 years). The follow-up duration for all 84 patients ranged from 18.30 to 158.83 months, with a median follow-up time of 42.82 (28.06, 103.12) months. In the longitudinal aortotomy-sandwich technique group (n=47), the rate of re-dilation ranged from –3.08 to 5.90 mm/year, with a median of 0.83 (0.27, 1.44) mm/year. There was no statistical difference in the rate of ascending aortic diameter re-dilation between patients with TAV and BAV within this group [0.65 (0.34, 1.43) mm/year vs. 0.99 (0.18, 1.44) mm/year, P=0.762]. In the external wrapping technique group (n=37), the rate of re-dilation ranged from –3.57 to 6.61 mm/year, with a median of 0.35 (–0.28, 0.96) mm/year. Similarly, there was no statistically significant difference in the rate of ascending aortic diameter re-dilation between patients with TAV and BAV within this group [0.33 (–0.17, 0.77) mm/year vs. 0.58 (–0.28, 1.05) mm/year, P=0.778]. ConclusionBAV does not significantly affect the rate of ascending aortic diameter re-dilation following ascending aorta remodeling.
ObjectiveTo evaluate the short and mid-term outcomes of valve repair in patients with insufficient bicuspid aortic valves (BAV).MethodsThe clinical data of 27 consecutive patients with insufficient BAV undergoing valve repair in Shanghai Chest Hospital from September 2016 to January 2020 were retrospectively reviewed. There were 24 males and 3 females with a mean age of 38.5±14.6 years (range: 20-68 years). BAV of all patients was type 1 in Seviers' classification. There were 23 patients with left-right fusion and 4 patients with right-noncoronary fusion. There was aortic regurgitation in the patients measured by the echocardiogram, including moderate regurgitation in 3 patients, moderate-severe in 18 patients, and severe in 6 patients. The diameter of aortic annular base was 27.9±3.4 mm, and the largest diameter of aortic sinus was 39.9±7.6 mm. Left ventricular end diastolic diameter was 62.7±6.5 mm, and the volume was 197.9±53.6 mL.ResultsAll 27 patients completed the follow-up, and the mean time was 24.2±12.5 months (range: 12-51 months). No patient died or required aortic valve-related reoperation during the follow-up. The cardiac function of the patients significantly improved postoperatively (P<0.05). By echocardiography, 11 patients had no aortic regurgitation, 13 had mild aortic regurgitation, and 3 had moderate aortic regurgitation, and no patient had severe aortic regurgitation. Postoperative left ventricular end diastolic diameter and volume decreased, compared to preoperative ones (P<0.05).ConclusionIn patients with insufficient BAV, valve repair is safe and effective, and has excellent short and mid-term outcomes.