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Abstract：
OBJECTIVE: Bicuspid aortic valves are associated with a poorly characterized connective tissue disorder that predisposes to aortic catastrophes. Because no criterion exists dictating the appropriate extent of aortic resection in aneurysmal disease of the bicuspid aortic valve, we studied the patterns of aortic dilation in this population.
METHODS: Sixty-four patients with bicuspid aortic valves who underwent computed tomographic or magnetic resonance angiography and echocardiography were retrospectively identified between January 2002 and March 2006. Orthonormal 2-dimensional or 3-dimensional aortic diameters were measured at 10 levels. Agglomerative hierarchic clustering with centered correlation distance measurements and complete linkage analysis was used to detect distinct patterns of aortic dilatation.
RESULTS: Mean aortic diameter was 28.1 +/- 0.7 mm at the annulus and 21.7 +/- 0.4 mm at the diaphragmatic hiatus. The aorta was largest in the tubular ascending aorta (45.9 +/- 1.0 mm). Compared with the descending aorta, the transverse aortic arch was also dilated (P < .01). Cluster analysis showed 4 patterns of aortic dilatation: cluster I, aortic root alone (n = 8, 13%); cluster II, tubular ascending aorta alone (n = 9, 14%); cluster III, tubular portion and transverse arch (n = 18, 28%); and, cluster IV, aortic root and tubular portion with tapering across the transverse arch (n = 29, 45%).
CONCLUSIONS: Distinct patterns of aortic dilatation in patients with bicuspid aortic valves call for an individualized degree of aortic replacement to minimize late aortic complications and reoperation. Patients in clusters III and IV should have transverse arch replacement (plus concomitant root replacement in cluster IV). Patients in cluster I should undergo complete aortic root replacement, whereas in patients in cluster II supracommissural ascending aortic grafting is adequate.
METHODS: Sixty-four patients with bicuspid aortic valves who underwent computed tomographic or magnetic resonance angiography and echocardiography were retrospectively identified between January 2002 and March 2006. Orthonormal 2-dimensional or 3-dimensional aortic diameters were measured at 10 levels. Agglomerative hierarchic clustering with centered correlation distance measurements and complete linkage analysis was used to detect distinct patterns of aortic dilatation.
RESULTS: Mean aortic diameter was 28.1 +/- 0.7 mm at the annulus and 21.7 +/- 0.4 mm at the diaphragmatic hiatus. The aorta was largest in the tubular ascending aorta (45.9 +/- 1.0 mm). Compared with the descending aorta, the transverse aortic arch was also dilated (P < .01). Cluster analysis showed 4 patterns of aortic dilatation: cluster I, aortic root alone (n = 8, 13%); cluster II, tubular ascending aorta alone (n = 9, 14%); cluster III, tubular portion and transverse arch (n = 18, 28%); and, cluster IV, aortic root and tubular portion with tapering across the transverse arch (n = 29, 45%).
CONCLUSIONS: Distinct patterns of aortic dilatation in patients with bicuspid aortic valves call for an individualized degree of aortic replacement to minimize late aortic complications and reoperation. Patients in clusters III and IV should have transverse arch replacement (plus concomitant root replacement in cluster IV). Patients in cluster I should undergo complete aortic root replacement, whereas in patients in cluster II supracommissural ascending aortic grafting is adequate.
摘要：
目的：二叶主动脉瓣与特征不明确的结缔组织疾病相关，易发生主动脉病变。因为没有标准规定二叶主动脉瓣动脉瘤疾病的主动脉切除的适当范围，我们研究了该人群的主动脉扩张模式.
方法：在2002年1月至2006年3月期间，对64例主动脉瓣二尖瓣患者进行了计算机断层扫描或磁共振血管造影术和超声心动图检查。在10个水平测量正交二维或三维主动脉直径。使用具有中心相关距离测量和完整连锁分析的聚集分层聚类来检测主动脉扩张的不同模式。
结果：瓣环处的平均主动脉直径为28.1+/-0.7mm，膈裂孔处的平均主动脉直径为21.7+/-0.4mm。在管状升主动脉中主动脉最大(45.9+/-1.0mm)。与降主动脉相比，横主动脉弓也扩张(P<.01)。聚类分析显示主动脉扩张的4种模式：I组，仅主动脉根（n=8，13%）；集群II，单独的肾小管升主动脉（n=9，14%）；第三组，管状部分和横弓(n=18，28%)；和，第四组，主动脉根部和管状部分，在横弓上逐渐变细（n=29，45％）。
结论：二叶主动脉瓣患者主动脉扩张的不同模式需要个体化程度的主动脉置换，以减少晚期主动脉并发症和再次手术。III和IV组的患者应进行横弓置换（加上IV组中伴随的根部置换）。I组患者应接受完整的主动脉根部置换，而在II组患者中，人工上升主动脉移植术是足够的。
方法：在2002年1月至2006年3月期间，对64例主动脉瓣二尖瓣患者进行了计算机断层扫描或磁共振血管造影术和超声心动图检查。在10个水平测量正交二维或三维主动脉直径。使用具有中心相关距离测量和完整连锁分析的聚集分层聚类来检测主动脉扩张的不同模式。
结果：瓣环处的平均主动脉直径为28.1+/-0.7mm，膈裂孔处的平均主动脉直径为21.7+/-0.4mm。在管状升主动脉中主动脉最大(45.9+/-1.0mm)。与降主动脉相比，横主动脉弓也扩张(P<.01)。聚类分析显示主动脉扩张的4种模式：I组，仅主动脉根（n=8，13%）；集群II，单独的肾小管升主动脉（n=9，14%）；第三组，管状部分和横弓(n=18，28%)；和，第四组，主动脉根部和管状部分，在横弓上逐渐变细（n=29，45％）。
结论：二叶主动脉瓣患者主动脉扩张的不同模式需要个体化程度的主动脉置换，以减少晚期主动脉并发症和再次手术。III和IV组的患者应进行横弓置换（加上IV组中伴随的根部置换）。I组患者应接受完整的主动脉根部置换，而在II组患者中，人工上升主动脉移植术是足够的。
