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Eur J Cardiothorac Surg 2002;22:1037-1038
© 2002 Elsevier Science NL
Letter to the Editor |
a Department of Public Medicine – Section of Pathology, Second University of Naples, Naples, Italy
b Department of Cardio-thoracic and Respiratory Sciences, Second University of Naples, Naples, Italy
Received 2 September 2002; accepted 4 September 2002.
* Corresponding author. Tel.: +39-81-770-1593; fax: +39-81-546-4594
e-mail: maurizio.cotrufo{at}uninaz.it
Key Words: Aortic valve disease • Medial degeneration • Coronary
The authors would like to thank Dr Veinot for his compliments to our work on the asymmetrical distribution of the different degrees of medial degeneration in the proximal aorta in patients with aortic valve disease [1]. Our study group of patients was quite inhomogeneous as to valve disease, including both cases of aortic valve stenosis and regurgitation, moreover from different aetiologies, such as rheumatic disease, dystrophic calcific degeneration, floppy valve.
Only in two patients the aortic valve was congenitally bicuspid: in one of them, a male 71-year-old patient, the valve was severely calcific and stenotic, while in the other patient (male, 44 years old) histology confirmed the diagnosis of rheumatic valve disease. In the first patient an aortic ratio of 1.56 was calculated; the degree of medial degeneration (MD) found at histology was 2 in the ‘right coronary’ specimen, 2 in the ‘non-coronary’ one. In the second patient the aortic ratio was found to be 1.81: the MD degree was 2 in the ‘right coronary’ specimen and 3 in the ‘non-coronary’ one. Therefore, although the numbers are too small to issue any conclusion, we can state that the two patients could be allocated to a subgroup characterized by the higher degrees of global MD expression. Nevertheless in several other patients, as was shown in Table 1, comparable degrees of MD were found, without the association with a bicuspid aortic valve.
At morphometry, the elastic lamellae in the aortic media of the two patients with bicuspid aortic valve were found to be particularly shortened, both in the right and in the non-coronary specimens and the distance between the lamellae appeared to be increased. These histological and morphometrical observations were consistent with other authors’ reports [2] and with Dr Veinot's investigation [3], in which only morphometry could establish the presence of a significant difference, not evident at histology, between the aortic media of patients with bicuspid and tricuspid aortic valve disease.
The bicuspid aortic valve, a congenital malformation found in about 20 out of 1000 live births [4], has been already shown to be associated with aortic wall abnormalities, and in particular with lower distensibility and higher stiffness indexes [5]. This could be the functional aspect of structural differences partially disclosed by morphological studies up to date. From a clinical point of view this reflects in the particularly frequent association of a bicuspid malfunctioning aortic valve and a mildly to severely dilated ascending aorta. Although some authors have recently reported about the treatment of the associated aortic enlargement through conservative aortoplasty in combination with valve replacement [6], we believe that a bicuspid valve should be considered a contraindication to conservative management, since the intrinsic abnormalities of the aortic wall exclude any guarantee of good long-term results as to recurrence of the dilatation.
References
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