Correlation of structural defects in the ascending aortic wall to ultrasound parameters: benefits for decision-making process in aortic valve surgery

• Published in: Journal of cardiothoracic surgery 2018-01, Vol.13 (1), p.12-12, Article 12
• Main Authors: Borović, Saša D, Labudović Borović, Milica M, Zaletel, Ivan V, Todorović, Vera N, Dabić, Petar A, Rakočević, Jelena T, Marinković-Erić, Jelena M, Milojević, Predrag S
• Format: Article
• Language: English
• Subjects: Aging; Analysis; Aortic stenosis; Aortic valve replacement; Aortic valve stenosis; Ascending aorta replacement; Care and treatment; Decision making; Patient outcomes; Remodeling
• ISSN: 1749-8090; 1749-8090
• DOI: 10.1186/s13019-017-0671-8

Histopathological changes in the ascending aorta wall in patients with severe tricuspid aortic valve (TAV) stenosis were graded and correlated to echocardiographic parameters. Objective was to associate threshold echocardiographic values with structural defects in the ascending aorta providing a tool to improve decision-making process in cases when simultaneous aortic valve replacement (AVR) and ascending aorta replacement is considered. Biopsies from 108 TAV stenosis patients subjected to AVR were graded into three grades according to severity of aortic wall changes. Echocardiographic parameters obtained preoperatively and correlated to grade, age, gender and risk factors, were diameters of ventriculo-aortic junction (AA), sinus Valsalva (SV), sinotubular junction (STJ), the largest diameter of the visualized ascending aorta (AscA) as well as indexes: sinus Valsalva (SVI), sinotubular junction (STJI), AscA/AA and STJ/AA. Two echocardiographic parameters portrayed grades with statistical significance: STJ (F = 5.417; p = 0.006 (p  3.5 cm, STJ > 2.9 cm and STJI > 1. Hemodynamic stress induced by TAV stenosis leads to elastic lamellae disruption in the aortic wall. Those changes could be graded and correlated with echocardiographic parameters of the aortic root and ascending aorta, providing a tool for decision to replace ascending aorta concomitantly with AVR.