Bicuspid aortic valve morphology and its association with aortic diameter: an echocardiographic study

Abstract

A b s t r a c tBackground: Bicuspid aortic valve (BAV) is strongly associated with aortopathy. Previous studies have suggested that various types of bicuspid aortic valve morphology may differently affect the aortic dilatation. Aim:To evaluate the impact of BAV cusp fusion morphology (type I -right-left coronary cusp fusion; type II -right-noncoronary cusp fusion) on the diameters of the aorta.Methods: BAV morphology was evaluated retrospectively in a group of 67 consecutive patients with BAV. The control group comprised 1000 randomly selected patients with normal tricuspid aortic valve. Aortic dimensions and other echocardiographic parameters were obtained from the echocardiography database of our department. The diameters of aorta in both BAV subtypes were evaluated at the level of: annulus, the sinus of Valsalva, the sinotubular junction, and the ascending aorta and at the level of the ascending aorta in the control group.Results: Patients with BAV were mainly male (78%), with a mean age of 55.3 ± 16.7 years. The dominant morphology of BAV in the study group was type I (n = 46; 69%). It was associated with increased aortic dimension in comparison to type II BAVs at the level of the sinuses of Valsalva (38.4 ± 5.2 vs. 34.0 ± 4.6 mm, p = 0.002), the sinotubular junction (33.1 ± 5.8 vs. 29.6 ± 5.0 mm, p = 0.035), and the ascending aorta (41.6 ± 7.1 vs. 36.6 ± 6.1 mm, p = 0.006). Indexed aortic diameter was also increased in type I BAV at the level of sinuses of Valsalva (19.6 ± 2.7 vs. 18.1 ± 1.6 mm/m 2 , p = 0.008) and the ascending aorta (21.3 ± 3.4 vs. 19.3 ± 3.4 mm/m 2 , p = 0.048). The dimensions of the ascending aorta exceeding the upper normal range limit based on control-group measurements (44.3 mm) were observed more frequently in type I than in type II (33% vs. 10%, p = 0.044). Aortic regurgitation (moderate or severe) occurred in similar percentages of both BAV subtypes (type I: 37% vs. type II: 33%, p = 0.774). There were also no significant differences in aortic valve area (2.2 ± 1.1 vs. 2.0 ± 1.4 cm 2 , p = 0.163), indexed aortic valve area (1.1 ± 0.6 vs. 1.0 ± 0.6, p = 0.337), peak transvalvular gradient (35.3 ± 20.5 vs. 39.1 ± 28.9 mm Hg, p = 0.862), and mean gradient (18.6 ± 12.3 vs. 22.7 ± 18.2 mm Hg, p = 0.571) and left ventricular ejection fraction (51.8 ± 11.6 vs. 51.8 ± 12.2%, p = 0.978) between type I and type II BAV groups.Conclusions: Type I BAV cusp fusion morphology is more commonly associated with dilatation of the aorta than type II, especially at the level of the sinus of Valsalva and the ascending aorta.

Bicuspid aortic valve and aortopathy — conundrum still unsolved?

“…Although these data were not presented, there was no significant difference in the presence of arterial hypertension or in the left ventricular (LV) echocardiographic size (LV mass, end diastolic and systolic diameters, and interventricular septal (IVS) thickness -indexed and non-indexed to body surface area) between the two BAV subtypes. This corroborates published [2] data on aortic stenosis severity and transvalvular pressure gradient data (peak and mean), similar in both BAV phenotypes. We feel that this is also consistent with haemodynamic theory of BAV aortopathy, which is supported by growing literature evidence [3] and is mentioned by Dr Ozturk.…”

“…We would like to thank Dr Ozturk et al [1] for their interest in our recent article regarding the impact of bicuspid aortic valve (BAV) morphology on the aortic diameter and for their insightful comments concerning the methodology of our study [2].…”

Association between bicuspid aortic valve phenotype and patterns of valvular dysfunction: A meta‐analysis

“…Then, full texts of 23 articles were analyzed. At last, 13 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 articles meet the inclusion criteria. The number of patients varied from 67 to 785, mean age ranged from 17.2 to 59 years, and the prevalence of male sex is from 60% to 78%.…”

Bicuspid aortic valve morphology and its impact on aortic diameters—A systematic review with meta‐analysis and meta‐regression

“…A total of 220 articles were analyzed as full texts. Of these, 23 met inclusion criteria: for analysis of SVD 4 studies with indexed, 12 with nonindexed and 4 with both aortic diameters and AAD 8 studies with indexed, 11 with nonindexed and 4 with both aortic diameters and were finally included in the meta‐analysis (Figure ). The final meta‐analysis included 1271 patients for the evaluation of indexed SVD and 3454 patients of nonindexed SVD and 2192 patients for evaluation of indexed AAD and 3104 for nonindexed AAD.…”