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Dissection rates in patients with bicuspid aortic valves surpass those in general population
Michelena H. JAMA. 2011;306:1104-1113.
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The incidence of aortic dissection in patients with bicuspid aortic valve is low, but higher than in the general population, new study results suggested.
In a comprehensive assessment of aortic complications in patients with bicuspid aortic valve, researchers analyzed echocardiography of patients with definite bicuspid aortic valve living in Olmsted County, Minnesota, searching for aortic complications in patients whose bicuspid valves had gone undiagnosed. Researchers defined their primary endpoint as the development of thoracic aorta dissection involving the ascending aorta (type A) or nonascending thoracic aorta (type B), ascending aortic aneurysm and surgery of the aorta.
Indications that researchers needed to view an echocardiogram were abnormal auscultatory findings, assessment of left ventricular function, suspected thoracic aorta disease cardiac and noncardiac symptoms, and follow-up of congenital heart disease. Overall, there were 416 patients with a definite diagnosis of bicuspid aortic valve by echocardiography, of whom 95% (n=393) completed follow-up.
According to the study, aortic dissection occurred in two of 416 patients, with an incidence of 3.1 (95% CI, 0.5-9.5) and an age-adjusted RR of 8.4 (95% CI, 2.1-33.5) vs. the county’s general population. Patients with aortic aneurysms at baseline had an aortic dissection incidence of 44.9 (95% CI, 7.5-138.5). During follow-up, 49 of 384 patients developed aneurysms (RR=86.2; 95% CI, 65.1-114). There were 49 of the 416 patients who underwent surgery of the thoracic aorta, which included 36 for elective aneurysm repair, according to the study.
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