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Final Thesis Wojnarski Corrected.pdf (1.96 MB)

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BICUSPID AORTIC VALVE AND ASSOCIATED AORTIC ANEURYSM PHENOTYPES: CLINICAL AND PATHOLOGIC ASSOCIATIONS

Wojnarski, Charles M
http://rave.ohiolink.edu/etdc/view?acc_num=case1427997162

Abstract Details

2015, Master of Sciences, Case Western Reserve University, Clinical Research.
Objectives: To determine if distinct patterns of aortopathy exist in patients with bicuspid aortic valves (BAV) and to characterize the association of aortopathy with valve morphology and dysfunction. Methods: We analyzed preoperative 3-dimensional computed tomography reconstructions for 656 patients with BAV undergoing ascending aorta surgery from 1/2001 to 1/2014. Partitioning around medoids was used to cluster patients based on data-driven similarities. Differences between groups were compared with a polytomous random forest model. Results: Three distinct morphologic aneurysm patterns were identified: root (n=83, 13%), ascending (n=364, 55%), and arch phenotype (n=209, 32%). Severe valve regurgitation was most prevalent in root phenotype (57%), followed by ascending (34%) and arch (26%; p < 0.0001). Aortic stenosis was most prevalent in arch phenotype (62%), followed by ascending (50%) and root (28%; p < 0.0001), and this relationship persisted when stenosis became severe (36%, 21%, and 11%, respectively; p < 0.0001). Patient age increased as extent of aneurysm became more distal (root; 49 years, ascending; 53 years, arch; 57 years; p < 0.0001) and root phenotype was associated with male predominance compared to ascending and arch (94%, 76%, and 70%, respectively; p < 0.0001). Conclusions: Patterns of aortopathy in BAV patients have different underlying pathophysiology. Root phenotype patient characteristics suggest a genetic etiology while ascending and arch aneurysms may have more hemodynamic underpinnings.
Eugene Blackstone, MD (Committee Chair)
Julian Kim, MD, MS (Committee Member)
James Spilsbury, PhD (Committee Member)
44 p.
Anatomy and Physiology; Medicine; Statistics
Aorta; aortopathy; bicuspid aortic valve; root; ascending; arch

Recommended Citations

Citations

  • Wojnarski, C. M. (2015). BICUSPID AORTIC VALVE AND ASSOCIATED AORTIC ANEURYSM PHENOTYPES: CLINICAL AND PATHOLOGIC ASSOCIATIONS [Master's thesis, Case Western Reserve University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=case1427997162

    APA Style (7th edition)

  • Wojnarski, Charles. BICUSPID AORTIC VALVE AND ASSOCIATED AORTIC ANEURYSM PHENOTYPES: CLINICAL AND PATHOLOGIC ASSOCIATIONS. 2015. Case Western Reserve University, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=case1427997162.

    MLA Style (8th edition)

  • Wojnarski, Charles. "BICUSPID AORTIC VALVE AND ASSOCIATED AORTIC ANEURYSM PHENOTYPES: CLINICAL AND PATHOLOGIC ASSOCIATIONS." Master's thesis, Case Western Reserve University, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=case1427997162

    Chicago Manual of Style (17th edition)

case1427997162
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© 2015, all rights reserved.
This open access ETD is published by Case Western Reserve University School of Graduate Studies and OhioLINK.