| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 2001;71:1067-1068
© 2001 The Society of Thoracic Surgeons
a Department of Pathology, University of Ottawa, University of Ottawa Heart Institute, Ottawa Hospital, Ottawa, Ontario, Canada
e-mail: jpveinot{at}ottawahospital.on.ca
To the Editor
I read with interest the results of the surgical series of patients undergoing surgery for congenitally bicuspid aortic valve with ascending aortic aneurysm [1]. Potential complications associated with congenitally bicuspid aortic valve, including valve stenosis and regurgitation and aortic dissection and aneurysm, are well documented.
The relationship between congenitally bicuspid aortic valve and aortic medial abnormalities has been attributed to a common embryonic origin of both tissues [2]. This association between bicuspid valve and aortic medial abnormality is no longer theoretical, as it has firm support by recent pertinent pathology studies [3, 4].
Our group examined the degree of aortic medial degenerative changes associated with congenitally bicuspid and tricuspid aortic valves in patients with aortic stenosis, who died shortly after aortic valve replacement [3]. I wondered if the data associating bicuspid aortic valve and aortic medial disease were biased to reflect patients with severe medial disease, as this association was derived mostly from case reports and series of patients with aortic dissection. Patients with aortic dissection were excluded from our study. Computer-aided morphometry clearly demonstrated that the aortas of congenitally bicuspid aortic valve patients had less elastic tissue than those patients with tricuspid aortic valves.
De Sa and associates also recently studied the medial pathology of the ascending aorta and the main pulmonary artery in patients with bicuspid aortic valve, tricuspid aortic valve, and normal valves [4]. They confirmed that patients with congenitally bicuspid aortic valve have more severe medial degenerative changes in the ascending aorta and the main pulmonary artery than patients with tricuspid valve disease. The importance of this interesting finding for patients undergoing the Ross procedure is emphasized.
All the pathology studies, to my knowledge, have focused on ascending aortic medial changes and there do not seem to be good studies of the pathology of the root. Postmortem studies may not yield useful information concerning the root and sinuses, as one would expect secondary pathology of this region of the aorta related to the surgery of valve insertion. The best modality to determine the fate of the root will probably be serial imaging studies.
There is good clinical and pathological evidence that congenitally bicuspid aortic valve may be associated with significant aortic medial disease. I still do not know if this is a problem with all patients or a subgroup of them. Until we know how to predict the fate of the aortic root and further details of the pathology of the aortic root are known, the study of Sundt and associates clearly demonstrates that both separate valve and aortic graft surgery and composite valve graft procedures will continue to have a place in the management of this group of patients [1].
References
This article has been cited by other articles:
|
|
 |
|
  G. Bol-Raap, J. Weerheim, A.P. Kappetein, M. Witsenburg, and A.J.J.C. Bogers Follow-up after surgical closure of congenital ventricular septal defect Eur. J. Cardiothorac. Surg., October 1, 2003; 24(4): 511 - 515. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
