{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T17:40:35Z","timestamp":1791308435216,"version":"4.3.1"},"reference-count":26,"publisher":"Texas Heart Institute Journal","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,3,1]]},"abstract":"\n Background<\/jats:title>\n Patients with bicuspid aortic valves (BAVs) tend to develop dilation of the ascending aorta. The aim of this study was to analyze the impact of leaflet fusion pattern on aortic root diameter and outcomes in patients undergoing surgery for BAV vs tricuspid aortic valve (TAV) disease.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This is a retrospective review of 90 patients with aortic valve disease (mean [SD] age, 51.5 [8.2] years) who underwent aortic valve replacement for BAV (n = 60) and TAV (n = 30). Fusion of right-left (R\/L) coronary cusps was identified in 45 patients, whereas the remaining 15 patients had right-noncoronary (R\/N) cusp fusion. Aortic diameter was measured at 4 levels, and Z values were computed.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n There were no significant differences between the BAV and TAV groups for age, weight, aortic insufficiency grade, or size of implanted prostheses. However, a higher preoperative peak gradient at the aortic valve was significantly associated with R\/L fusion (P<\/jats:italic> = .02). Preoperative Z values of ascending aorta and sinotubular junction diameter were significantly higher in patients with R\/N fusion than with the R\/L (P<\/jats:italic> < .001 and P<\/jats:italic> = .04, respectively) and TAV (P<\/jats:italic> < .001 and P<\/jats:italic> < .05, respectively) subgroups. During the follow-up period (mean [SD], 2.7 [1.8] years), 3 patients underwent a redo procedure. At the last follow-up, the sizes of ascending aorta were similar among all 3 patient groups.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n This study suggests that preoperative dilation of the ascending aorta is more common in patients with R\/N fusion than in patients with R\/L and TAV but is not significantly different between all groups in the early follow-up period. R\/L fusion was associated with an increased risk of preoperative presence of aortic stenosis.<\/jats:p>\n <\/jats:sec>","DOI":"10.14503\/thij-21-7831","type":"journal-article","created":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T19:43:34Z","timestamp":1679946214000},"source":"Crossref","is-referenced-by-count":3,"title":["The Impact of Bicuspid Aortic Valve Leaflet Fusion Morphology on the Ascending Aorta and on Outcomes of Aortic Valve Replacement"],"prefix":"10.14503","volume":"50","author":[{"given":"Steve","family":"Bibevski","sequence":"first","affiliation":[{"name":"Section of Pediatric Cardiothoracic Surgery, Joe DiMaggio Children's Hospital, Hollywood, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Ruzmetov","sequence":"additional","affiliation":[{"name":"Section of Pediatric Cardiothoracic Surgery, Joe DiMaggio Children's Hospital, Hollywood, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan F.","family":"Plate","sequence":"additional","affiliation":[{"name":"Section of Adult Cardiac Surgery, Memorial Regional Hospital, Hollywood, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank G.","family":"Scholl","sequence":"additional","affiliation":[{"name":"Section of Pediatric Cardiothoracic Surgery, Joe DiMaggio Children's Hospital, Hollywood, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"5628","reference":[{"issue":"3","key":"i1526-6702-50-2-e217831-b1","series-title":"Ann Thorac Surg.","doi-asserted-by":"publisher","first-page":"931","DOI":"10.1016\/j.athoracsur.2006.10.047","article-title":"Risk factors associated with reoperation and mortality in 252 patients after aortic valve replacement for congenitally bicuspid aortic valve disease","volume":"83","year":"2007","unstructured":"Goland\n S,\n \n \n Czer\n LS,\n \n \n De Robertis\n MA,\n \n \n .\n\t\t\t\t\tRisk factors associated with reoperation and mortality in 252 patients after aortic valve replacement for congenitally bicuspid aortic valve disease.\n\t\t\t\t\tAnn Thorac Surg.2007;83(3):931\u2013937.\n\t\t\t\t\tdoi:10.1016\/j.athoracsur.2006.10.047"},{"issue":"6","key":"i1526-6702-50-2-e217831-b2","series-title":"Ann Thorac Surg.","doi-asserted-by":"publisher","first-page":"1981","DOI":"10.1016\/j.athoracsur.2016.05.038","article-title":"Effect of aortic valve replacement on aortic root dilatation rate in patients with bicuspid and tricuspid aortic valves","volume":"102","year":"2016","unstructured":"Regeer\n MV,\n \n \n Versteegh\n MI,\n \n \n Klautz\n RJ,\n \n \n .\n\t\t\t\t\tEffect of aortic valve replacement on aortic root dilatation rate in patients with bicuspid and tricuspid aortic valves.\n\t\t\t\t\tAnn Thorac Surg.2016;102(6):1981\u20131987.\n\t\t\t\t\tdoi:10.1016\/j.athoracsur.2016.05.038"},{"issue":"6","key":"i1526-6702-50-2-e217831-b3","series-title":"Ann Thorac Surg.","doi-asserted-by":"publisher","first-page":"2101","DOI":"10.1016\/j.athoracsur.2015.02.036","article-title":"The association between aortic valve leaflet morphology and patterns of aortic dilation in patients with bicuspid aortic valves","volume":"99","year":"2015","unstructured":"Ruzmetov\n M,\n \n \n Shah\n JJ,\n \n \n Fortuna\n RS,\n \n \n Welke\n KF.\n \n \n The association between aortic valve leaflet morphology and patterns of aortic dilation in patients with bicuspid aortic valves.\n\t\t\t\t\tAnn Thorac Surg.2015;99(6):2101\u20132107.\n\t\t\t\t\tdoi:10.1016\/j.athoracsur.2015.02.036"},{"issue":"4","key":"i1526-6702-50-2-e217831-b4","series-title":"J Thorac Cardiovasc Surg.","doi-asserted-by":"publisher","first-page":"937","DOI":"10.1016\/j.jtcvs.2007.11.072","article-title":"Is aortic wall degeneration related to bicuspid aortic valve anatomy in patients with valvular disease?","volume":"136","year":"2008","unstructured":"Russo\n CF,\n \n \n Cannata\n A,\n \n \n 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Surg.2016;49(2):439\u2013446.\n\t\t\t\t\tdoi:10.1093\/ejcts\/ezv087"},{"issue":"10","key":"i1526-6702-50-2-e217831-b6","series-title":"JAMA.","doi-asserted-by":"publisher","first-page":"1104","DOI":"10.1001\/jama.2011.1286","article-title":"Incidence of aortic complications in patients with bicuspid aortic valves","volume":"306","year":"2011","unstructured":"Michelena\n HI,\n \n \n Khanna\n AD,\n \n \n Mahoney\n D,\n \n \n .\n\t\t\t\t\tIncidence of aortic complications in patients with bicuspid aortic valves.\n\t\t\t\t\tJAMA.2011;306(10):1104\u20131112.\n\t\t\t\t\tdoi:10.1001\/jama.2011.1286"},{"issue":"6","key":"i1526-6702-50-2-e217831-b7","series-title":"Circ J.","doi-asserted-by":"publisher","first-page":"1356","DOI":"10.1253\/circj.CJ-15-1378","article-title":"Valve phenotype and risk factors of aortic dilatation after aortic valve replacement in Japanese patients with bicuspid aortic valve","volume":"80","year":"2016","unstructured":"Kinoshita\n T,\n \n \n Naito\n S,\n \n \n Suzuki\n T,\n \n \n Asai\n T.\n \n \n Valve phenotype and risk factors of aortic dilatation after aortic valve replacement in Japanese patients with bicuspid aortic valve.\n\t\t\t\t\tCirc J.2016;80(6):1356\u20131361.\n\t\t\t\t\tdoi:10.1253\/circj.CJ-15-1378"},{"issue":"1","key":"i1526-6702-50-2-e217831-b8","series-title":"J Card Surg.","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1111\/jocs.14294","article-title":"Does the pattern of bicuspid aortic valve leaflet fusion determine the success of the Ross procedure?","volume":"35","year":"2020","unstructured":"Ruzmetov\n M,\n \n \n Fortuna\n RS,\n \n \n Shah\n JJ,\n \n \n Welke\n KF,\n \n \n Plunkett\n MD.\n \n \n Does the pattern of bicuspid aortic valve leaflet fusion determine the success of the Ross procedure?\n \n J Card Surg.\n \n 2020;35(1):28\u201334.\n\t\t\t\t\tdoi:10.1111\/jocs.14294"},{"issue":"13","key":"i1526-6702-50-2-e217831-b9","series-title":"Circulation.","doi-asserted-by":"publisher","first-page":"e266","DOI":"10.1161\/CIR.0b013e3181d4739e","article-title":"2010 ACCF\/AHA\/AATS\/ACR\/ASA\/SCA\/SCAI\/SIR\/STS\/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: executive summary. A report of the American College of Cardiology Foundation\/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine","volume":"121","year":"2010","unstructured":"Hiratzka\n LF,\n \n \n Bakris\n GL,\n \n \n Beckman\n JA,\n \n \n .\n\t\t\t\t\t2010 ACCF\/AHA\/AATS\/ACR\/ASA\/SCA\/SCAI\/SIR\/STS\/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: executive summary. A report of the American College of Cardiology Foundation\/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine.\n\t\t\t\t\tCirculation.2010;121(13):e266\u2013e369.\n\t\t\t\t\tdoi:10.1161\/CIR.0b013e3181d4739e"},{"issue":"2","key":"i1526-6702-50-2-e217831-b10","series-title":"JACC Cardiovasc Imaging.","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1016\/j.jcmg.2012.11.007","article-title":"Association between bicuspid aortic valve phenotype and patterns of valvular dysfunction and bicuspid aortopathy: comprehensive evaluation using MDCT and echocardiography","volume":"6","year":"2013","unstructured":"Kang\n JW,\n \n \n Song\n HG,\n \n \n Yang\n DH,\n \n \n .\n\t\t\t\t\tAssociation between bicuspid aortic valve phenotype and patterns of valvular dysfunction and bicuspid aortopathy: comprehensive evaluation using MDCT and echocardiography.\n\t\t\t\t\tJACC Cardiovasc Imaging.2013;6(2):150\u2013161.\n\t\t\t\t\tdoi:10.1016\/j.jcmg.2012.11.007"},{"issue":"3","key":"i1526-6702-50-2-e217831-b11","series-title":"Eur J Echocardiogr.","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1093\/ejechocard\/jeq030","article-title":"European Association of Echocardiography recommendations for the assessment of valvular regurgitation. 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Part 1: aortic and pulmonary regurgitation (native valve disease).\n\t\t\t\t\tEur J Echocardiogr.2010;11(3):223\u2013244.\n\t\t\t\t\tdoi:10.1093\/ejechocard\/jeq030"},{"issue":"1","key":"i1526-6702-50-2-e217831-b12","series-title":"J Pediatr.","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1016\/s0022-3476(78)80601-5","article-title":"Geometric method for measuring body surface area: a height-weight formula validated in infants, children, and adults","volume":"93","year":"1978","unstructured":"Haycock\n GB,\n \n \n Schwartz\n GJ,\n \n \n Wisotsky\n DH.\n \n \n Geometric method for measuring body surface area: a height-weight formula validated in infants, children, and adults.\n\t\t\t\t\tJ Pediatr.1978;93(1):62\u201366.\n\t\t\t\t\tdoi:10.1016\/s0022-3476(78)80601-5"},{"issue":"S1","key":"i1526-6702-50-2-e217831-b13","series-title":"Structural Heart.","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1080\/24748706.2019.1590096","article-title":"The impact of bicuspid 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shape.\n\t\t\t\t\tHeart.2008;94(12):1634\u20131638.\n\t\t\t\t\tdoi:10.1136\/hrt.2007.132092"},{"issue":"3","key":"i1526-6702-50-2-e217831-b15","series-title":"Eur J Cardiothorac Surg.","doi-asserted-by":"publisher","first-page":"e118","DOI":"10.1016\/j.ejcts.2011.04.014","article-title":"Bicuspid aortic valve leaflet morphology in relation to aortic root morphology: a study of 300 patients undergoing open-heart surgery","volume":"40","year":"2011","unstructured":"Jackson\n V,\n \n \n Petrini\n J,\n \n \n Caidahl\n K,\n \n \n .\n\t\t\t\t\tBicuspid aortic valve leaflet morphology in relation to aortic root morphology: a study of 300 patients undergoing open-heart surgery.\n\t\t\t\t\tEur J Cardiothorac Surg.2011;40(3):e118\u2013e124.\n\t\t\t\t\tdoi:10.1016\/j.ejcts.2011.04.014"},{"issue":"24","key":"i1526-6702-50-2-e217831-b16","series-title":"J Am Coll Cardiol.","doi-asserted-by":"publisher","first-page":"2312","DOI":"10.1016\/j.jacc.2009.07.044","article-title":"Bicuspid aortic valves with different spatial orientations of the leaflets are distinct etiological entities","volume":"54","year":"2009","unstructured":"Fern\u00e1ndez\n B,\n \n \n Dur\u00e1n\n AC,\n \n \n Fern\u00e1ndez-Gallego\n T,\n \n \n .\n\t\t\t\t\tBicuspid aortic valves with different spatial orientations of the leaflets are distinct etiological entities.\n\t\t\t\t\tJ Am Coll Cardiol.2009;54(24):2312\u20132318.\n\t\t\t\t\tdoi:10.1016\/j.jacc.2009.07.044"},{"issue":"15","key":"i1526-6702-50-2-e217831-b17","series-title":"J Am Coll Cardiol.","doi-asserted-by":"publisher","first-page":"1786","DOI":"10.1016\/j.jacc.2016.02.015","article-title":"Functional aortic root parameters and expression of aortopathy in bicuspid versus tricuspid aortic valve stenosis","volume":"67","year":"2016","unstructured":"Girdauskas\n E,\n \n \n Rouman\n M,\n \n \n Disha\n K,\n \n \n .\n\t\t\t\t\tFunctional aortic root parameters and expression of aortopathy in bicuspid versus tricuspid aortic valve stenosis.\n\t\t\t\t\tJ Am Coll Cardiol.2016;67(15):1786\u20131796.\n\t\t\t\t\tdoi:10.1016\/j.jacc.2016.02.015"},{"issue":"4","key":"i1526-6702-50-2-e217831-b18","series-title":"Circ Cardiovasc Imaging.","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1161\/CIRCIMAGING.112.973370","article-title":"Bicuspid aortic valve is associated with altered wall shear stress in the ascending aorta","volume":"5","year":"2012","unstructured":"Barker\n AJ,\n \n \n Markl\n M,\n \n \n B\u00fcrk\n J,\n \n \n .\n\t\t\t\t\tBicuspid aortic valve is associated with altered wall shear stress in the ascending aorta.\n\t\t\t\t\tCirc Cardiovasc Imaging.2012;5(4):457\u2013466.\n\t\t\t\t\tdoi:10.1161\/CIRCIMAGING.112.973370"},{"issue":"6","key":"i1526-6702-50-2-e217831-b19","series-title":"J Magn Reson Imaging.","doi-asserted-by":"publisher","first-page":"1342","DOI":"10.1002\/jmri.24498","article-title":"From unicuspid to quadricuspid: influence of aortic valve morphology on aortic three-dimensional hemodynamics","volume":"40","year":"2014","unstructured":"Entezari\n P,\n \n \n Schnell\n S,\n \n \n Mahadevia\n R,\n \n \n .\n\t\t\t\t\tFrom unicuspid to quadricuspid: influence of aortic valve morphology on aortic three-dimensional hemodynamics.\n\t\t\t\t\tJ Magn Reson Imaging.2014;40(6):1342\u20131346.\n\t\t\t\t\tdoi:10.1002\/jmri.24498"},{"issue":"5","key":"i1526-6702-50-2-e217831-b20","series-title":"Am J Cardiol.","doi-asserted-by":"publisher","first-page":"718","DOI":"10.1016\/j.amjcard.2005.04.051","article-title":"Frequency of bicuspid aortic valve in young male conscripts by echocardiogram","volume":"96","year":"2005","unstructured":"Nistri\n S,\n \n \n Basso\n C,\n \n \n Marzari\n C,\n \n \n Mormino\n P,\n \n \n Thiene\n G.\n \n \n Frequency of bicuspid aortic valve in young male conscripts by echocardiogram.\n\t\t\t\t\tAm J Cardiol.2005;96(5):718\u2013721.\n\t\t\t\t\tdoi:10.1016\/j.amjcard.2005.04.051"},{"issue":"5","key":"i1526-6702-50-2-e217831-b21","series-title":"Ann 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M,\n \n \n Manfrin\n M,\n \n \n Moraca\n A,\n \n \n .\n\t\t\t\t\tAortic dimensions in patients with bicuspid aortic valve without significant valve dysfunction.\n\t\t\t\t\tAm J Cardiol.2005;95(2):292\u2013294.\n\t\t\t\t\tdoi:10.1016\/j.amjcard.2004.08.098"},{"issue":"2","key":"i1526-6702-50-2-e217831-b23","series-title":"Heart.","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1136\/heartjnl-2013-304920","article-title":"Aortic dilatation patterns and rates in adults with bicuspid aortic valves: a comparative study with Marfan syndrome and degenerative aortopathy","volume":"100","year":"2014","unstructured":"Detaint\n D,\n \n \n Michelena\n HI,\n \n \n Nkomo\n VT,\n \n \n Vahanian\n A,\n \n \n Jondeau\n G,\n \n \n Sarano\n ME.\n \n \n Aortic dilatation patterns and rates in adults with bicuspid aortic valves: a comparative study with Marfan syndrome and degenerative aortopathy.\n\t\t\t\t\tHeart.2014;100(2):126\u2013134.\n\t\t\t\t\tdoi:10.1136\/heartjnl-2013-304920"},{"key":"i1526-6702-50-2-e217831-b24","series-title":"Cardiol Res Pract.","doi-asserted-by":"publisher","first-page":"313879","DOI":"10.1155\/2012\/313879","article-title":"Current indications for surgical repair in patients with bicuspid aortic valve and ascending aortic ectasia","volume":"2012","year":"2012","unstructured":"Etz\n CD,\n \n \n Misfeld\n M,\n \n \n Borger\n MA,\n \n \n Luehr\n M,\n \n \n Strotdrees\n E,\n \n \n Mohr\n FW.\n \n \n Current indications for surgical repair in patients with bicuspid aortic valve and ascending aortic ectasia.\n\t\t\t\t\tCardiol Res Pract.2012;2012:313879.\n\t\t\t\t\tdoi:10.1155\/2012\/313879"},{"issue":"1","key":"i1526-6702-50-2-e217831-b25","series-title":"Ann Thorac Surg.","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1016\/j.athoracsur.2013.03.086","article-title":"Dilatation of the remaining aorta after aortic valve or aortic 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Surg.2014;45(5):e128\u2013e135.\n\t\t\t\t\tdoi:10.1093\/ejcts\/ezt666"}],"container-title":["Texas Heart Institute 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