二瓣化主动脉病变特点及其与瓣膜病变的关系

Characteristics of bicuspid aortic valve aortopathy and association with valvular phenotype and dysfunction

目的总结二瓣化主动脉病变特点,并分析其与瓣膜病变之间的关系。方法回顾性分析2017年6月—2018年3月在阜外医院进行首次主动脉瓣手术的191例主动脉瓣二瓣化畸形(bicuspid aortic valve,BAV)患者的临床资料,术中明确BAV分型,术前所有患者进行主动脉多层螺旋CT及心脏超声检查,排除主动脉缩窄患者,其中男143例、女48例,平均年龄(53.91±12.52)岁。应用聚类分析与主观分类相结合的方法对主动脉病变特点进行分析,BAV分型根据瓣膜开放方向不同分为前后型与左右型。结果BAV主动脉病变特点如下:普通型(无扩张或轻度扩张)70例,根部型(主动脉窦部扩张)24例,升主动脉型(升主动脉扩张)72例,弓部型(主动脉弓部扩张)25例。根部型以年轻患者为主,弓部型以年长患者为主,差异有统计学意义(P<0.05)。根部型的BAV形态以前后排列为主,多合并主动脉瓣关闭不全;弓部型以左右排列为主,多合并主动脉瓣狭窄,差异有统计学意义(P<0.05)。主动脉手术干预111例(58.1%),主动脉病变特点与手术方案的一致率为80.6%。结论根据扩张部位的不同,BAV主动脉病变共分为4种类型,BAV瓣膜形态、功能状态与主动脉病变之间存在相关性。

Objective To summarize the characteristics of bicuspid aortic valve(BAV)aortopathy and analyze the association between aortopathy and BAV phenotype and patterns of valvular dysfunction.Methods Clinical data of 191 patients who underwent the first aortic valve replacement in Fuwai Hospital from June 2017 to March 2018 were retrospectively analyzed,including 143 males and 48 females with an average age of 53.91±12.52 years.All patients underwent multidetector computed tomography(MDCT)and echocardiography before the operation,excluding patients with aortic coarctation.The BAV aortopathy phenotype was classified during operation.The characteristics of BAV aortopathy were analyzed by cluster and artificial analysis.BAV anatomic phenotype was divided into two types according to the direction of valve opening:BAV-AP and BAV-LR.Results Four distinct BAV aortopathy phenotypes were identified:a common type(n=70,36.6%),with no dilation or mild dilation of aorta;a root type(n=24,12.6%),with predominant dilatation of aortic sinus;an ascending aorta type(n=72,37.7%),with predominant dilatation of ascending aorta;an arch type(n=25,13.1%),with predominant dilatation of aortic arch dilatation.The root type was mainly in young patients,while the arch type was mainly in elderly patients(P<0.05).BAV-AP and aortic insufficiency were most prevalent in root type,while BAV-LR and aortic stenosis were most prevalent in arch type(P<0.05).There were 111(58.1%)patients undergoing aortic surgery,and the coincidence rate of BAV aortopathy phenotype and aortic surgery was 80.6%.Conclusion According to the location of aortic dilation,BAV aortopathy can be divided into four types.There is an association between BAV aortopathy and valvular phenotype and dysfunction.