心脏CTA评价主动脉瓣二瓣畸形对升主动脉增宽的影响

Relationship between Bicuspid Aortic Valve and Ascending Aortic Dilatation Assessed by Computed Tomography Angiography

目的通过CTA研究主动脉瓣二瓣畸形(bicuspid aortic valve,BAV)与升主动脉扩张部位和扩张程度之间的关系。方法回顾性分析2012年2月至2015年4月我院收治的124例主动脉瓣二瓣畸形合并可疑主动脉增宽或主动脉瘤患者的临床资料,其中男97例、女27例,年龄(50.35±16.26)岁。所有患者均行心电门控CTA检查,根据主动脉瓣瓣叶是否存在脊,可将其分为无脊BAV组和有脊BAV组。测量主动脉瓣环、窦部、窦管交界、管状升主动脉、升主动脉近无名动脉处、弓部(近左锁骨下动脉处)最宽处直径并观察记录主动脉增宽的部位及直径、瓣膜形态等。结果 124例患者中有91例(73.4%)患者为有脊BAV,33例(26.6%)患者为无脊BAV。有脊BAV与无脊BAV患者瓣环[(23.90±3.34)mm vs.(21.74±3.46)mm,P=0.005]、窦部[(40.93±6.78)mm vs.(37.35±7.06)mm,P=0.022]、管状升主动脉[(45.38±7.66)mm vs.(38.29±8.18)mm,P=0.0001]及无名动脉近端的主动脉直径[(34.19±4.98)mm vs.(30.23±6.62)mm,P=0.02)差异有统计学意义。同时右冠窦与左冠窦瓣叶融合型(R-L融合型)与右冠窦与无冠窦瓣叶融合型(R-N融合型)有脊BAV患者相比,其瓣环[(25.13±2.15)mm vs.(23.40±1.69)mm,P=0.028]、窦部[(43.58±3.65)mm vs.(39.16±2.89)mm,P=0.0002]、窦管交界直径[(41.05±4.25)mm vs.(38.57±3.21)mm,P=0.036]明显增宽,差异有统计学意义。R-N融合型患者升主动脉末端及弓部近端主动脉直径相较R-L融合型明显增宽,差异有统计学意义[(39.95±5.07)mm vs.(37.24±3.96)mm,P=0.005]。结论有脊BAV比无脊BAV更常见,且常常伴有升主动脉增宽和升主动脉瘤的形成。同时R-L融合型BAV与主动脉根部扩张关系密切,而R-N融合型BAV与升主动脉末端及弓部近端扩张关系更加密切。

Objective To find the relationship between bicuspid aortic valve （BAV） and the dilatation or aneurysm of the aorta using electrocardiogram-gated computed tomography angiography （CTA）. Methods We collected the clinical data of the BAV coexisting with suspected aortic dilatation or aneurysm from February 2012 through April 2015. A total of 124 patients were analyzed retrospectively. There were 97 males and 27 females at an anverage age of 50.35±16.26 years. According to the CTA, patients were classified into two groups： a pure BAV（without raphe） group and a BAV （with raphe） group. We recorded the aortic diameters, gender, age, and so on. Results Of the 124 patients, 91 （73.4%） had BAV with raphe, and 33 patients （26.6%） had pure BAV. The analysis revealed that the diameter of the annulus （23.90±3.34 mm vs. 21.74±3.46 mm, P=0.005）, the sinuses of Valsalva （40.93±6.78 mm vs. 37.35±7.06 mm, P=0.022）, the tubular portion of the ascending aorta （45.38±7.66 mm vs. 38.29±8.18 mm, P=0.0001）, and the part of the aorta proximal to the innominate artery （34.19±4.98 mm vs. 30.23±6.62 mm, P=0.02） between patients with BAV with raphe and pure BAV had significant differences. And there was a significant difference in prevalence of dilatation of the aorta between patients with pure BAV and BAV with raphe [77/91 （84.6%） vs.i8/31（58.1%）, P=0.0041. Of the 91 BAV with raphe patients, we found 76 patients （83.5%） with right and left coronary cusps （R-L） fusion, 13 patients （14.3%） with right and non-coronary cusps （R-N） fusion, and 2 patients （1.2%） with left and non-coronary cusps （L-N） fusion. There was a statistical difference in the aortic root diameters between R-L fusion BAV and R-N fusion BAV. The diameter of the distal ascending aorta and proximal aortic arch between R-L and R-N fusion BAV had statistical differences. Conclusions BAV with raphe is more common than pure BAV and is more often associated with dilatation and aneurysm of the ascending aorta. Otherwise R-L fusion BAV is associated with increased diameters of the aortic root, while R-N fusion BAV is associated with increased diameters of the distal ascending aorta and proximal arch.