Novel Method of Assessing Ascending Aorta with a Stenotic Bicuspid Aortic Valve.

BACKGROUND AND AIM OF THE STUDY: Patients with bicuspid aortic valve (BAV) have an increased risk of serious aortic complications such as aortic dissection, rupture and dilatation of the ascending aorta. Previous findings have suggested that ascending aortic dilatation with a BAV has a typical asymmetric configuration at the right-anterior aspect of the aorta. The study aim was to quantify asymmetric configurations of the aorta using a three-dimensional (3D) reconstruction tool.

METHODS: A retrospective review was conducted of 52 patients (27 males, 25 females; mean age 69 ? 9 years) with aortic stenosis who presented with ascending aortic dilatation defined as an aortic diameter >35 mm. Of these patients, 24 (46%) had a BAV and 28 (54%) had a tricuspid aortic valve (TAV). A patient-specific 3D thoracic aortic model was reconstructed from computed tomography (CT) data. Three-dimensional centerlines were automatically calculated. The size of the ascending aorta was determined by calculating the cross-sectional area (in mm2) of the vertical section against the centerline. The symmetry of the dilated aorta was evaluated as the ellipticity of the maximum vertical section of the ascending aorta. The size and symmetry of the ascending aorta, and background factors including pressure gradient, aortic valve area, degree of regurgitation, ejection fraction and cardiovascular risk factors, were compared between the BAV and TAV groups.

RESULTS: Only age differed significantly between the groups (p = 0.003). The size and ellipticity of the ascending aorta and the maximum cross-sectional area of the aortic arch were significantly greater in the BAV group (p = 0 .001 and p = 0.004, respectively).

CONCLUSION: The ascending aorta assessed using Mimics 3D reconstruction software was frequently asymmetrically dilated in stenotic BAV, and the expansion progressed to the aortic arch. It is believed that calculating the ellipticity of the vertical section against the centerline offers an innovative means of quantifying aortic symmetry in three dimensions.