In the population of patients with BAV, the incidence of aortic dissection over a mean of 16 years of follow-up was low but significantly higher than in the general population.

Background-Bicuspid aortic valve is frequent and is reported to cause numerous complications, but the clinical outcome of patients diagnosed with normal or mildly dysfunctional valve is undefined. Methods and Results-In 212 asymptomatic community residents from Olmsted County, Minn (age, 32Ϯ20 years; 65% male), bicuspid aortic valve was diagnosed between 1980 and 1999 with ejection fraction Ն50% and aortic regurgitation or stenosis, absent or mild. Aortic valve degeneration at diagnosis was scored echocardiographically for calcification, thickening, and mobility reduction (0 to 3 each), with scores ranging from 0 to 9. At diagnosis, ejection fraction was 63Ϯ5% and left ventricular diameter was 48Ϯ9 mm. Survival 20 years after diagnosis was 90Ϯ3%, identical to the general population (Pϭ0.72). Twenty years after diagnosis, heart failure, new cardiac symptoms, and cardiovascular medical events occurred in 7Ϯ2%, 26Ϯ4%, and 33Ϯ5%, respectively. Twenty years after diagnosis, aortic valve surgery, ascending aortic surgery, or any cardiovascular surgery was required in 24Ϯ4%, 5Ϯ2%, and 27Ϯ4% at a younger age than the general population (PϽ0.0001). No aortic dissection occurred. Thus, cardiovascular medical or surgical events occurred in 42Ϯ5% 20 years after diagnosis. Independent predictors of cardiovascular events were age Ն50 years (risk ratio, 3.0; 95% confidence interval, 1.5 to 5.7; PϽ0.01) and valve degeneration at diagnosis (risk ratio, 2.4; 95% confidence interval, 1.2 to 4.5; Pϭ0.016; Ͼ70% events at 20 years). Baseline ascending aorta Ն40 mm independently predicted surgery for aorta dilatation (risk ratio, 10.8; 95% confidence interval, 1.8 to 77.3; PϽ0.01). Conclusions-In the community, asymptomatic patients with bicuspid aortic valve and no or minimal hemodynamic abnormality enjoy excellent long-term survival but incur frequent cardiovascular events, particularly with progressive valve dysfunction. Echocardiographic valve degeneration at diagnosis separates higher-risk patients who require regular assessment from lower-risk patients who require only episodic follow-up. (Circulation. 2008;117:2776-2784.)

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Clinically significant (greater or equal to moderate) TR is common in community residents diagnosed by Doppler echocardiography and increases with age. Isolated TR is associated with excess mortality, thus TR represents an important public health problem.