Biomechanical properties and histomorphometric features of aortic tissue in patients with or without bicuspid aortic valve

Carmela Rita Balistreri, Maria Giovanna Scioli, Denise Bellisario, Calogera Pisano, Loredana Santo, Paolo Nardi, Sara Rita Vacirca, Federico D'Amico, Paolo Nardi, Claudia Altieri, Roberto Verzicco, Federico D'Amico, Marco Talice, Marco Talice, Fabio Bertoldo, Roberto Verzicco, Giovanni Ruvolo, Augusto Orlandi, Sara Rita Vacirca

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Background: We sought to investigate and compare biomechanical properties and histomorphometric findings of thoracic ascending aorta aneurysm (TAA) tissue from patients with bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) in order to clarify mechanisms underlying differences in the clinical course. Methods: Circumferential sections of TAA tissue in patients with BAV (BAV-TAA) and TAV (TAV-TAA) were obtained during surgery and used for biomechanical tests and histomorphometrical analysis. Results: In BAV-TAA, we observed biomechanical higher peak stress and lower Young modulus values compared with TAV-TAA wall. The right lateral longitudinal region seemed to be the most fragile zone of the TAA wall. Mechanical stress-induced rupture of BAV-TAA tissue was sudden and uniform in all aortic wall layers, whereas a gradual and progressive aortic wall breakage was described in TAV-TAA. Histomorphometric analysis revealed higher amount of collagen but not elastin in BAV-TAA tunica media. Conclusions: The higher deformability of BAV-TAA tissue supports the hypothesis that increased wall shear stress doesn't explain the increased risk of sudden onset of rupture and dissection; other mechanisms, likely related to alteration of specific genetic pathways and epigenetic signals, could be investigated to explain differences in aortic dissection and rupture in BAV patients.
Original languageEnglish
Pages (from-to)2304-2316
Number of pages13
JournalJournal of Thoracic Disease
Publication statusPublished - 2020

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine


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