Известно, что пациенты с двустворчатым аортальным клапаном (ДАК), в том числе без гемодинамических нарушений на клапане, склонны к развитию дилатации и расслоению корня и восходящего отдела аорты по сравнению с лицами соответствующего возраста и пола, имеющими трехстворчатый аортальный клапан (ТАК). Низкая прогностическая ценность применяемых на сегодняшний день биомаркеров риска развития диссекции аорты обуславливает поиск новых методов диагностики ранних проявлений ДАК-ассоциированной аортопатии. Целью исследования явилась оценка эластических свойств аорты у пациентов с ДАК методом двухмерной спекл-трекинг эхокардиографии (впервые предложенным нами в Республике Беларусь в качестве инструмента оценки функции аорты) у пациентов с ДАК с дилатацией аорты и без в сравнении с пациентами с ТАК. Обследовано 47 пациентов (22 пациента с ДАК, средний возраст 44 года; 25 здоровых добровольцев, средний возраст 44 года). Установлено, что у пациентов с ДАК в 100% случаев имеется ассоциированная аортопатия, характеризующаяся увеличением размеров корня аорты на всех анатомических уровнях (преимущественно в синотубулярном гребне), сопровождаясь в каждом ¼ случае дилатацией стенки аорты. В качестве раннего маркера развития ДАК-ассоциированной аортопатии с нарушением эластических свойств аорты может служить снижение глобальной циркулярной деформации (9,8 (1,7) % vs 7,64 (3,9) %; p = 0,01) на фоне увеличенных показателей растяжимости и жесткости аорты.

1. Жане А. К. Эволюция методов хирургического лечения аневризм брюшной аорты //Креативная кардиология. – 2011. – № 2. – С. 18–23.

2. Рудой А. С., Бова А. А., Валюженич Я. И., Островский Ю. П. Первый опыт применения в Республике Беларусь технологии 2D speckle-tracking эхокардиографии для оценки сократимости грудного отдела аорты// Медицинские новости. 2019. – № 4. – С. 14–17.

3. Atkins S. K., Moore A. N., Sucosky P. Bicuspid aortic valve hemodynamics does not promote remodeling in porcine aortic wall concavity //World journal of cardiology. – 2016. – Т. 8. – № 1. – С. 89.

4. Benedik, J., Pilarzcyk, K., Wendt, D., Price, V., Tsagakis, K., Perrey, M. Is there any difference in aortic wall quality between patients with aortic stenosis and those with regurgitation?. European Journal of Cardio-Thoracic Surgery, 2013, 44(4), 754–759.

5. Beroukhim RS, Kruzick TL, Taylor AL, Gao D, Yetman AT. Progression of aortic dilation in children with a functionally normal bicuspid aortic valve. Am J Cardiol. 2006;98:828-30.

6. Biaggi, P., Matthews, F., Braun, J., Rousson, V. Gender, Age, and Body Surface Area are the Major Determinants of Ascending Aorta Dimensions in Subjects With Apparently Normal Echocardiograms. Journal of the American Society of Echocardiography, 2009, 22(6), 720–725.

7. Borger M. A. et al. The American Association for Thoracic Surgery consensus guidelines on bicuspid aortic valve–related aortopathy: Full online-only version //The Journal of thoracic and cardiovascular surgery. – 2018. – Т. 156. – №. 2. – С. e41-e74.

8. Braverman AC, Guven H, Beardslee MA, et al. The bicuspid aortic valve. Curr Probl Cardiol. 2005;30(9):470–522.

9. Ciotti GR, Vlahos AP, Silverman NH. Morphology and function of the bicuspid aortic valve with and without coarctation of the aorta in the young. Am J Cardiol. 2006;98:1096–1102.

10. DeCampli W. M., Wilder T. J. et al. Is a hybrid strategy a lowerrisk alternative to stage 1 Norwood operation? // The Journal of thoracic and cardiovascular surgery. – 2017. – Т. 153. – № 1. – С. 163–172.

11. Della Corte, A., Bancone, C., Dialetto, G. Towards an individualized approach to bicuspid aortopathy: different valve types have unique determinants of aortic dilatation†. European Journal of CardioThoracic Surgery, 2014, 45(4), e118–e124.

12. Della Corte, A., Bancone, C., Dialetto, G.. The ascending aorta with bicuspid aortic valve: a phenotypic classification with potential prognostic significance. European Journal of Cardio-Thoracic Surgery, 2014, 46(2), 240–247.

13. Della Corte, A., Bancone, C., Quarto, C.. Predictors of ascending aortic dilatation with bicuspid aortic valve: a wide spectrum of disease expression. European Journal of Cardio-Thoracic Surgery, 2007, 31(3), 397–405.

14. Devereux RB, de Simone G, Arnett DK, Best LG, Boerwinkle E, Howard BV, Kitzman D, Lee ET, Mosley TH Jr., Weder A, Roman MJ. Normal limits in relation to age, body size and gender of two-dimensional echocardiographic aortic root dimensions in persons ≥ 15 years of age. Am J Cardiol 2012;110:1189–1194.

15. Elefteriades, J. A., & Farkas, E. A.. Thoracic Aortic Aneurysm. Journal of the American College of Cardiology, 2010, 55 (9), 841–857.

16. Entezari, P., Schnell, S., Mahadevia, R.. From unicuspid to quadricuspid: Influence of aortic valve morphology on aortic three-dimensional hemodynamics. Journal of Magnetic Resonance Imaging, 2013, 40(6), 1342–1346.

17. Erbel R., Aboyans V., Boileau C., Bossone E., Bartolomeo R. D., et al.. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur. Heart J. 2014, 35, 2873–2926.

18. Ferencik M, Pape LA. Changes in size of ascending aorta and aortic valve function with time in patients with congenitally bicuspid aortic valves. Am J Cardiol. 2003;92:43-6.

19. Girdauskas E, Disha K, Borger MA, et al. Relation of bicuspid aortic valve morphology to the dilatation pattern of the proximal aorta: focus on the transvalvular flow. Cardiol Res Pract. 2012;2012:478259.

20. Habchi K. M., Ashikhmina E., Vieira V. M.. Association between bicuspid aortic valve morphotype and regional dilatation of the aortic root and trunk. Int. J. Cardiovasc. Imaging. 2017, 33, 341–349.

21. Halushka, M. K., Angelini, A., Bartoloni, G.. Consensus statement on surgical pathology of the aorta from the Society for Cardiovascular Pathology and the Association For European Cardiovascular Pathology: II. Noninflammatory degenerative diseases–nomenclature and diagnostic criteria. Cardiovascular pathology, 2016, 25(3), 247–257.

22. Hiratzka LF, Bakris GL, Beckman JA. 2010 ACCF/AHA/AATS/ ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease. Circulation; 2010 Apr 6;121(13).

23. Jassal, D. S., Bhagirath, K. M., Tam, J. W. Association of Bicuspid Aortic Valve Morphology and Aortic Root Dimensions: A Substudy of the Aortic Stenosis Progression Observation Measuring Effects of Rosuvastatin (ASTRONOMER) Study. Echocardiography, 2010, 27(2), 174–179.

24. Johnston KW, Rutherford RB, Tilson MD, Shah DM, Hollier L, Stanley JC. Suggested standards for reporting on arterial aneurysms. Subcommittee on Reporting Standards for Arterial Aneurysms, Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery. J Vasc Surg. 1991;13:452–8.

25. Kimmenade RR, Kempers M, de Boer MJ, Loeys BL, Timmermans J. A clinical appraisal of different Z-score equations for aortic root assessment in the diagnostic evaluation of Marfan syndrome. Genet Med. 2013;15:528–532

26. Kinoshita N, Mimura J, Obayashi C, Katsukawa F, Onishi S, Yamazaki H. Aortic root dilatation among young competitive athletes: echocardiographic screening of 1929 athletes between 15 and 34 years of age. Am Heart J. 2000;139:723–728

27. Matthias Bechtel JF, Noack F, Sayk F, et al. Histopathological grading of ascending aortic aneurysm: comparison of patients with bicuspid versus tricuspid aortic valve. J Heart Valve Dis. 2003;12(1):54–59.

28. Michelena H. I., Khanna A. D., Mahoney D.. Incidence of aortic complications in patients with bicuspid aortic valves. JAMA 306, 2011, 1104–1112.

29. Nagueh, S. F. Recommendations for the evaluation of leftventricular diastolic function by echocardiography // Journal of the American society of echocardiography. – 2009. – Vol. 22. – P. 108–133.

30. Nistri S, Grande-Allen J, Noale M, Basso C, Siviero P, Maggi S, et al. Aortic elasticity and size in bicuspid aortic valve syndrome. Eur Heart J 2008;29:472–9.

31. Pasta S, Phillippi JA, Gleason TG, Vorp DA. Effect of aneurysm on the mechanical dissection properties of the human ascending thoracic aorta. J Thorac Cardiovasc Surg. 2012;143:460–7.

32. Pichamuthu JE, Phillippi JA, Cleary DA, Chew DW, Hempel J, Vorp DA, et al.Differential tensile strength and collagen composition in ascending aortic aneu-rysms by aortic valve phenotype. Ann Thorac Surg. 2013;96:2147–54.

33. Raaz U, Zollner AM, Schellinger IN, Toh R, Nakagami F, Brandt M, et al. Segmental aortic stiffening contributes to experimental abdominal aortic aneurysm development. Circulation. 2015;131:1783–95.

34. Raghav, V., Barker, A. J., Mangiameli, D., Mirabella, L., Markl, M., & Yoganathan, A. P. Valve mediated hemodynamics and their association with distal ascending aortic diameter in bicuspid aortic valve subjects. Journal of Magnetic Resonance Imaging, 2017, 47(1), 246–254.

35. Schaefer, B. M., Lewin, M. B., Stout, K. K., Gill, E., Prueitt, A., Byers, P. H., & Otto, C. M.. The bicuspid aortic valve: an integrated phenotypic classification of leaflet morphology and aortic root shape. Heart, 2008, 94(12), 1634–1638.

36. Siu SC, Silversides CK. Bicuspid aortic valve disease. J Am Coll Cardiol. 2010;55:2789–800.

37. Wolak A. et al. Aortic size assessment by noncontrast cardiac computed tomography: normal limits by age, gender, and body surface area // JACC: Cardiovascular Imaging. – 2008. – Т. 1. – № 2. – С. 200–209.

38. Yasuda H, Nakatani S, Stugaard M, et al. Failure to prevent progressive dilation of ascending aorta by aortic valve replacement in patients with bicuspid aortic valve: comparison with tricuspid aortic valve. Circulation. 2003;108(Suppl 1):291–294.