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Progressive Dilation of the Ascending Aorta in Children With Isolated Bicuspid Aortic Valve

2007; Elsevier BV; Volume: 99; Issue: 7 Linguagem: Inglês

10.1016/j.amjcard.2006.10.065

1879-1913

Kathryn W. Holmes, Christoph U. Lehmann, Darshan Dalal, Khuram Nasir, Harry C. Dietz, William Ravekes, William Thompson, Philip J. Spevak,

Cardiac Valve Diseases and Treatments

Although patients with bicuspid aortic valves (BAVs) are predisposed to ascending aortic (AA) dilation, stenosis, and dissection, the development of aortic disease in children with BAVs is poorly described. The purposes of this study were to determine the rate of change of AA diameter in children with BAVs and to identify risk factors for the development of aortic dilation. The echocardiograms of 276 children aged 4), and 70 (25%) were moderately abnormal (z between 2 and 4). The mean ± SD AA diameter increased more than expected, at a rate of 0.18 ± 0.30 z score per year (p 2, at follow-up. Univariate analysis demonstrated right-noncoronary commissural fusion (p <0.02) and aortic valve gradient on initial examination (p <0.02) as significant predictors of AA growth. In multivariate analysis, however, the significance of gradient and valve morphology was diminished (p = 0.06 for both). In conclusion, the progression of AA diameter in patients with normal z scores on initial examination suggests that serial echocardiograms are required to screen for the development of significant aortic dilation. Although patients with bicuspid aortic valves (BAVs) are predisposed to ascending aortic (AA) dilation, stenosis, and dissection, the development of aortic disease in children with BAVs is poorly described. The purposes of this study were to determine the rate of change of AA diameter in children with BAVs and to identify risk factors for the development of aortic dilation. The echocardiograms of 276 children aged 4), and 70 (25%) were moderately abnormal (z between 2 and 4). The mean ± SD AA diameter increased more than expected, at a rate of 0.18 ± 0.30 z score per year (p 2, at follow-up. Univariate analysis demonstrated right-noncoronary commissural fusion (p <0.02) and aortic valve gradient on initial examination (p <0.02) as significant predictors of AA growth. In multivariate analysis, however, the significance of gradient and valve morphology was diminished (p = 0.06 for both). In conclusion, the progression of AA diameter in patients with normal z scores on initial examination suggests that serial echocardiograms are required to screen for the development of significant aortic dilation.