Authors : A. Sathish Selvakumar, Sudheer Arava, Ruma Ray, S.K. Choudhary
DOI : 10.18231/2394-6792.2019.0002
Volume : 6
Issue : 1
Year : 2019
Page No : 9-15
Objectives: Bicuspid Aortic Valve Disease (BAVD) is a rare entity associated with ascending aortic aneurysm. We present the histopathological and morphometric data of BAVD cases who had thoracic aortic aneurysms requiring surgical intervention.
Materials and Methods: Thirteen cases of BAVD from 298 cases of ascending thoracic aortic aneurysms requiring surgical intervention between 1995 to 2009 were included. Controls were obtained from autopsy cases with normal aortic valve. Tunica intima was examined for fibrosis (FIB-1), and inflammation (INFL1). Tunica media was examined for lamellar count (LC) and inflammation (INFL 2) whereas elastic fragmentation (EF), cystic medial degeneration (CMD), medionecrosis (MN), smooth muscle disarray (SMD) and fibrosis (FIB-2) were graded by semi-quantitative grading system. CMD was subjected to morphometric area measurement. Tunica adventitia was examined for fibrosis (FIB 3) and inflammation (INFL 3).
Results: In media EF (P<.001), SMD (P=.002), FIB-2 (P=.002) and MN (P=.02) were significantly greater in cases than controls. More BAVD cases had CMD (low grade =76.92%, moderate grade = 7.69% and high grade = 15.38%), when compared to only 6 controls (46.15%) having low grade CMD, although statistically not significant. Mean LC was greater in controls than cases (P= <0 P=0.041)>
Conclusion: Patients with BAVD have significant degenerative medial changes of ascending thoracic aorta causing aneurysmal dilatation. They require surveillance, risk factor assessment and clinical disease management of aneurysmal complication.
Keywords: Bicuspid aortic valve, Aortic aneurysm, Tunica media, Disease management.