The Effect of Losartan in Bicuspid Aortic Valve Patients
The Effect of Losartan in Bicuspid Aortic Valve Patients
The specific aims of this study are to:

 -  Establish baseline levels of circulating MMP-2 and -9 , TIMP-1and- 2 and TGFB levels in
 individuals with bicuspid aortic valve and ascending aortic or aortic sinus measurements
 >40mm.

 -  Assess the effect on MMP levels during treatment with losartan, an angiotensin II
 receptor blocking agent.

 -  In the setting of losartan therapy for one year, evaluate the response of MMP levels in
 these patients, and clinical outcomes including effects on aortic growth rate
Inclusion Criteria:

 -  Adults >age 18 years and < 65 years old

 -  Able to give informed consent

 -  Presence of a bicuspid aortic valve (functional or true bicommisural)and ascending
 aorta or sinus of Valsalva >4.0cm

 -  No contraindications to treatment with Losartan, an Angiotensin II receptor blocker

 -  Able to safely participate in a 4 week drug washout period if currently taking an
 angiotensin II receptor blocker or ACE inhibitor.

 Exclusion Criteria:

 -  Unable to safely take losartan due to one or more of the following:

 -  Hypersensitivity to losartan or other angiotensin receptor blockers

 -  Pregnancy

 -  Nursing mothers

 -  History of angioedema

 -  Hypotension - chronically volume depleted patients

 -  Hepatic or renal impairment (Cr>1.5mg/dL)

 -  Hyperkalemia (K+>4.8)

 -  Renal artery stenosis

 -  Severe congestive heart failure (class III-IV)

 -  Currently taking potassium supplements or salt substitutes containing potassium

 -  Currently taking lithium

 -  Prior surgical intervention to aorta or aortic valve

 -  Unable or unwilling to give informed consent and follow up with study activities

 -  Currently taking an angiotensin receptor blocker or ACE inhibitor specifically for
 hypertension and are therefore unable to or are unwilling to participate in a 4 week
 drug washout period.

 -  Females of child bearing who are unwilling to practice adequate birth control
 throughout the study.