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Comparative Histology of Aortic Dilatation Associated With Bileaflet Versus Trileaflet Aortic Valves
Resected aortas associated with a bicuspid aortic valve (BAV,n = 60) and trileaflet aortic valve (n = 24) in patients with aortic valve disease were compared with normal diameter aortas from patients undergoing cardiac transplantation (n = 16) by five histologic criteria. The extent of elastic fiber loss, smooth muscle cell loss, medial fibrosis, and atherosclerosis was more severe in trileaflet aortic valve than BAV when considered across all diameters and when stratified to those between 4 and 5 cm. This finding begs the question: Should the guideline-recommended more aggressive threshold for replacing the aorta in BAV patients as compared to trileaflet aortic valve patients be revisited?