What is the relationship between aortic aneurysm and aortic valve (AV) lesions?

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Last updated: March 1, 2025 • View editorial policy

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From the Guidelines

Aortic aneurysms and aortic valve lesions often coexist, and their management should prioritize a comprehensive assessment of the aorta and the aortic valve, both at baseline and during follow-up, as emphasized by the 2014 ESC guidelines 1.

Key Considerations

  • The presence of an aortic aneurysm may be associated with other locations of aneurysms, such as iliac or popliteal aneurysms, which should be considered in the general work-up of patients with aortic aneurysms 1.
  • Patients with aortic aneurysms are at increased risk of cardiovascular events, mostly unrelated to the aneurysm, but plausibly related to common risk factors and pathways, such as smoking or hypertension 1.
  • The management of aortic aneurysms should focus on the lesion, and surgical intervention is typically recommended when the aortic aneurysm reaches 5.0-5.5 cm in diameter, or earlier if rapid growth (>0.5 cm/year) occurs.

Medical Management

  • Blood pressure control with beta-blockers, such as metoprolol 25-100 mg twice daily, to reduce aortic wall stress.
  • Statins, like atorvastatin 20-40 mg daily, to stabilize atherosclerotic plaques.
  • Lifestyle modifications, including smoking cessation, moderate exercise avoiding heavy lifting, and maintaining blood pressure below 130/80 mmHg.

Surgical Intervention

  • Combined valve replacement and aneurysm repair is usually performed during the same operation for patients with both conditions.
  • Valve-sparing aortic replacement is increasingly employed in expert centers, especially in young patients, to treat combined aortic root dilatation and valve regurgitation 1.

Imaging Surveillance

  • Regular imaging surveillance with echocardiography every 6-12 months and CT angiography annually to monitor aneurysm size and valve function.
  • The importance of a full assessment of the aorta and the aortic valve in patients with aortic aneurysms, both at baseline and during follow-up, cannot be overstated, as highlighted by the 2014 ESC guidelines 1.

From the Research

Relationship Between Aortic Aneurysm and Aortic Valve Lesions

  • Aortic aneurysms and aortic valve lesions are closely related, with aortic valve lesions often occurring in conjunction with aortic aneurysms 2, 3.
  • The presence of an aortic aneurysm can lead to aortic valve insufficiency, which can be addressed through valve-sparing operations 2, 4, 3.
  • Valve-sparing aortic root replacement is a viable option for patients with aortic root aneurysms and preservable aortic valves, providing excellent clinical outcomes and stable valve function over several decades 4.
  • The technique of reimplantation of the aortic valve may provide a more stable repair of the aortic valve than remodeling of the aortic root 3.
  • Combined procedures, such as transcatheter aortic valve replacement and endovascular aneurysm repair, can be performed under local anesthesia with percutaneous access, reducing hospital stay and providing technical success 5.

Anatomical and Technical Considerations

  • The anatomy of the ascending aorta can pose limitations for endovascular repair of aortic aneurysms, making open surgery the gold standard for management of ascending aneurysms 6.
  • The aortic annulus diameter and leaflet morphology are important factors in determining the feasibility of valve-sparing operations 2, 3.
  • Echocardiography is a crucial imaging modality for determining the feasibility of valve-sparing root replacement and assessing valve function post-operatively 2, 4, 3.

Clinical Outcomes and Durability

  • Valve-sparing aortic root replacement provides excellent clinical outcomes and stable valve function over several decades 4.
  • The long-term results of aortic valve sparing for aortic root aneurysms are excellent, with reimplantation of the aortic valve providing a more stable repair of the aortic valve than remodeling of the aortic root 3.
  • Combined procedures, such as transcatheter aortic valve replacement and endovascular aneurysm repair, can provide technical success and reduced hospital stay 5.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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