The difference between a BAV Aorta and a Normal Aorta - Microscopically

[Duff Man]

Is it just me, or is there almost a complete blackout of knowledge when it comes to what is actually wrong with the bicuspid aorta? Maybe this is a silly question, but have any molecular biologists looked at and contrasted the normal aorta vs the bicuspid aorta under a microscope? Maybe we should look closer at the similarities and differences between the marfan aorta and the bicsupid aorta, eh? Clearly there is something wrong on the molecular level, and the shape of the valve and the pressures coming from it are not the sole offender.

Why not design a study that examines what TGF-b is doing to the bicuspid aorta, if anything?

If we do not know the cause of the problem, how can we prevent the problem? For that matter, how can we truly fix it?

Discuss with me!

 

[skeptic49]

Duffman,

I think that bicuspid aortic valve disease is still not well understood. What you are advocating sounds very much like what the GenTAC registry currently recruiting participants is trying to lay the groundwork for:

A group of patients with certain genetic conditions is currently being recruited to establish the GenTAC Registry. The information collected through the registry will help doctors and researchers better understand the link between genes and aortic aneurysms and heart disease. GenTAC will also enable research to determine the best ways to manage the complications of cardiovascular disease that can arise from some genetic disorders. Better understanding and more research will lead to better treatment.

The web site for GenTAc is here:
https://gentac.rti.org/Default.aspx?tabid=36

As a matter of fact, I have an appointment at 10 Am today to give blood samples. I signed up to be a participant.

Jim

 

[Mentu]

DM, my surgeon says that the tissues themselves do not appear to be different between an aortic valve with one, two or three leaflets and that most people will never know anything about their valves because most do not become seriously stenotic. However, depsite the similarities in appearance, he thinks that some individuals may have some very subtle altered protein on the surface of their heart valves that foster the development of severe stenosis. Further, he is pretty confident that one day genetic studies will help identify the difference which conceivably will allow doctors to identify individuals likely to develope severe stenosis, but this is not the only problem. Since many people with tissue valves go on to develope stenosis again, there does seem to be some agent at work involving blood chemistry that is separate from the heart which may actually be the more important trigger. There are still many questions and no clear answers. Take care.

Larry

 

[ALCapshaw2]

Is it just me, or is there almost a complete blackout of knowledge when it comes to what is actually wrong with the bicuspid aorta? Maybe this is a silly question, but have any molecular biologists looked at and contrasted the normal aorta vs the bicuspid aorta under a microscope? Maybe we should look closer at the similarities and differences between the marfan aorta and the bicsupid aorta, eh? Clearly there is something wrong on the molecular level, and the shape of the valve and the pressures coming from it are not the sole offender.

Why not design a study that examines what TGF-b is doing to the bicuspid aorta, if anything?

If we do not know the cause of the problem, how can we prevent the problem? For that matter, how can we truly fix it?

Discuss with me!

HUH?

Aren't you speaking of a Bicuspid Aortic VALVE ?

I've never heard of a Bicuspid AORTA.

After all the research you have conducted I'm sure you know the difference and expected you would use the proper terminology.

 

[normofthenorth]

Play nice, guys! (Thanks God I never make misteaks!)

Larry/Mentu: You say "Since many people with tissue valves go on to develop stenosis again, there does seem to be some agent at work involving blood chemistry that is separate from the heart which may actually be the more important trigger."

Have you seen a study indicating that AVR patients who were BAVers experience (say) shorter time until Structural Valve Deterioration than NON-BAVers of the same age? Or were you just pointing out that tissue valves don't last forever, in all patients? If it's the former, I thought I'd read through the discussion here about CTD, and I don't remember seeing that. It's also been notably absent in several recent discussions here helping people (many of them BAV) choose between and among valves.

 

[Lionheart]

Duff,
I guess you've tried Google scholar-
http://scholar.google.com/scholar?hl=en&as_sdt=4000&q=TGF-b+and+bicuspid+aortic+valve
How close are you to a larger hospital or a university library? Hospitals have medical libraries and universities have access to huge database search engines that pull up scholarly articles on any subject. Most of them also have free online access to the actual article. Biochemistry was too long ago for me to remember so I don't have much else to contribute.
I have university access if you find something you really want to read, PM me with complete Journal name, primary author, first page number, and first part of title. I might be able to get a PDF. Often most any good library can get an interlibrary loan PDF of almost any journal article.
Best,
John

 

[Duff Man]

HUH?

Aren't you speaking of a Bicuspid Aortic VALVE ?

I've never heard of a Bicuspid AORTA.

After all the research you have conducted I'm sure you know the difference and expected you would use the proper terminology.

I was referring to the aorta of a bicsupid valver. A bicuspid aorta... because it's not the same as a regular aorta to me. To me, calling it just an aorta would be like calling the marfan aorta an aorta. We know the marfan aorta is not the same as a regular aorta, and I think it's fair to say the bicuspid aorta is not the same either. They're so different in my mind that it might merit distinguishing in the way I did.

Al, I do appreciate you keeping me on my toes. Truly I do. If anyone says something bogus and no one calls the error(s) out, we're in trouble - everyone that reads it. It reminds me of the quote "No man is wise enough by himself"

 

[Duff Man]

Play nice, guys! (Thanks God I never make misteaks!)

Larry/Mentu: You say "Since many people with tissue valves go on to develop stenosis again, there does seem to be some agent at work involving blood chemistry that is separate from the heart which may actually be the more important trigger."

Have you seen a study indicating that AVR patients who were BAVers experience (say) shorter time until Structural Valve Deterioration than NON-BAVers of the same age? Or were you just pointing out that tissue valves don't last forever, in all patients? If it's the former, I thought I'd read through the discussion here about CTD, and I don't remember seeing that. It's also been notably absent in several recent discussions here helping people (many of them BAV) choose between and among valves.

I personally have seen studies that talk about how the BAV degenerates faster and also acknowledges the aorta of the bicuspid valver expanding and ultimately dissecting much sooner than the general population.

Duff,
I guess you've tried Google scholar-
http://scholar.google.com/scholar?hl=en&as_sdt=4000&q=TGF-b+and+bicuspid+aortic+valve
How close are you to a larger hospital or a university library? Hospitals have medical libraries and universities have access to huge database search engines that pull up scholarly articles on any subject. Most of them also have free online access to the actual article. Biochemistry was too long ago for me to remember so I don't have much else to contribute.
I have university access if you find something you really want to read, PM me with complete Journal name, primary author, first page number, and first part of title. I might be able to get a PDF. Often most any good library can get an interlibrary loan PDF of almost any journal article.
Best,
John

John, I really, really appreciate the offer. I'll take you up on it at some point, I'm sure. In the past I just paid a one time fee for the article. I couldn't resist!

Duffman,

I think that bicuspid aortic valve disease is still not well understood. What you are advocating sounds very much like what the GenTAC registry currently recruiting participants is trying to lay the groundwork for:



The web site for GenTAc is here:
https://gentac.rti.org/Default.aspx?tabid=36

As a matter of fact, I have an appointment at 10 Am today to give blood samples. I signed up to be a participant.

Jim

The GENTAC study is fantastic, but I just don't feel like it goes far enough. I feel like we should be looking at these different aortas underneath a microscope, or in a laboratory, or something. If we look at it and we can see empirical evidence of any difference between the types, we might be able to treat the progression of aortic disease sooner than if we just simply study the aortas retrospectively. I guess I'm advocating proactive research instead of reactive.

I guess my frustration lies in the passive/slowly progressive nature of the treatment for Bicuspid valvers, and especially the aorta of a bicuspid valver.

 

[ALCapshaw2]

I was referring to the aorta of a bicsupid valver.

(AL C) AH, now I understand where you are 'coming from'. That is a clearer way of expressing your intention.

A bicuspid aorta... because it's not the same as a regular aorta to me. To me, calling it just an aorta would be like calling the marfan aorta an aorta. We know the marfan aorta is not the same as a regular aorta, and I think it's fair to say the bicuspid aorta is not the same either. They're so different in my mind that it might merit distinguishing in the way I did.

YES, I agree. BAV patients, and especially congenital BAV patients, are more likely to also have connective tissue disorders that affect the aorta. 'AL C'

Al, I do appreciate you keeping me on my toes. Truly I do. If anyone says something bogus and no one calls the error(s) out, we're in trouble - everyone that reads it. It reminds me of the quote "No man is wise enough by himself"

AL C responses in red italics above.

 

[ALCapshaw2]

I guess my frustration lies in the passive/slowly progressive nature of the treatment for Bicuspid valvers, and especially the aorta of a bicuspid valver.

That is understandable. Awareness of the association between BAV and Connective Tissue Disorders seems to be greatest at the Major Heart Hospitals where they see more of these types of patients. I seem to recall a few members who had BAV and later developed Aneurysms that required a repeat surgery. One wonders how many of these repeat surgeries could have been avoided by proper intervention during the First Surgery.

'AL Capshaw'

 

[normofthenorth]

Great discussion, and very "close to my heart"!

Duff Man, I'm aware of studies showing that BAVs deteriorate faster than (say) TAVs, and that we BAVers, on average, have faster deterioration of our ARs and our Aortas. What I haven't seen is studies showing that REPLACEMENT tissue AVs implanted in us BAVers deteriorate faster than comparable valves implanted in non-BAVers. If there's no such study, the world is crazy, because that info would be trivially easy to extract from the enormous existing databases (like the 1134-patient database of Hancock-II recipients at Toronto General alone!), and of enormous importance to both BAVers and non-BAVERs making valve-type decisions! Heck, you non-BAVers are lovely folks, but YOUR expectation for AVR durability is not "interesting" to me in quite the same way as the expectation for AVR durability in a BAVer like me! And vice versa, I'm sure. If the age-corrected average time before SVD (signif. valve deterioration) is significantly different for our two groups, then showing us AVERAGE numbers is diluting the gold with slag.

The question of the durability of us BAVers Aortas is of unusual interest to me right now, because I just got wired and stitched back up WITHOUT getting the Dacron Aortic Root replacement I was expecting! My fancy surgical team looked at what I had, and decided that the tissue looked pretty good, and the dilation wasn't very extreme ("certainly less than 5 cm" he said), so all it needed was a little surgical "tuck" to make it even tighter. I actually asked one of the surgeons "But what about Connective Tissue Disorder, and the risk that the AR will behave badly in the future? Are you convinced that I'm not in the ~40% of BAVers that have CTD?" He said that they viewed CTD as more of a continuum than a "yes/no" diagnosis, and my tissue looked relatively normal.

Of course, I got the standard written warrantee, so I can relax.

 

[Lynlw]

Norm, I don't have any stats, but my thinking would be that it seems that BAV can have weak tissue to start with..not something about their chemistry that breaks down tissue faster. SO I would think that since the valve they replace it with wouldn't be affected or wouldn't wear out /break down quicker in someone with BAV than it would in other people their age.

 

[Lily]

www.bicuspidfoundation.com is a site with a lot of information on this subject.

But there are still many "unknowns" about the bicuspid condition, or degrees of the condition.