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J Thorac Cardiovasc Surg 2004;127:686-691
© 2004 The American Association for Thoracic Surgery

Surgery for acquired cardiovascular disease

Matrix metalloproteinase activity in thoracic aortic aneurysms associated with bicuspid and tricuspid aortic valves

^a Department of Surgery, Division of Cardiothoracic Surgery, Fletcher Allen Health Care and the University of Vermont, Burlington, Vt, USA

Read at the Twenty-ninth Annual Meeting of The Western Thoracic Surgical Association, Carlsbad, Calif, June 18-21, 2003.

Received for publication June 20, 2003; revisions received October 22, 2003; accepted for publication November 4, 2003.

^* Address for reprints: Joseph D. Schmoker, MD, Division of Cardiothoracic Surgery/Fletcher Allen Health Care, Fletcher 454, 111 Colchester Avenue, Burlington, VT , 05401, USA
joseph.schmoker{at}vtmednet.org

OBJECTIVE: Matrix metalloproteinases are endopeptidases that function in cell matrix turnover. Abnormal matrix metalloproteinase activity has been implicated in the formation of atherosclerotic abdominal aortic aneurysms. Recent studies suggest that abnormal matrix metalloproteinase activity may also be associated with the formation of atherosclerotic and nonatherosclerotic thoracic aortic aneurysms. Bicuspid aortic valves are associated with an intrinsic aortic pathology that predisposes to formation of proximal thoracic aneurysms while tricuspid aortic valves are not. The objective of this study was to compare the activities of matrix metalloproteinases and levels of their inhibitors in thoracic aneurysms of patients with bicuspid and tricuspid aortic valves.

METHODS: Endogenous and total activity of matrix metalloproteinase-2 and matrix metalloproteinase-9 were measured in proximal nonatherosclerotic thoracic aortic aneurysms of 16 patients with bicuspid aortic valves and 12 patients with tricuspid aortic valves. Levels of tissue inhibitor metalloproteinase-1 and -2 were also measured. Results were standardized to total protein (mg).

RESULTS: Total matrix metalloproteinase-2 activity was greater in aneurysms associated with bicuspid valves when compared with those from tricuspid valves (43 ± 11 ng/mg vs 14 ± 2 ng/mg, P = .02). Total matrix metalloproteinase-9 activity was also greater in aneurysms associated with bicuspid aortic valves (4.0 ± 0.9 vs 1.5 ± 0.3, P = .02). There was no meaningful difference between groups in levels of tissue inhibitor-1 and -2.

CONCLUSION: The increased activity of matrix metalloproteinases in the walls of aneurysms associated with bicuspid aortic valves may partly explain the predilection to aneurysm formation in these patients.

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