Investigation of the morphology of the bicuspid aortic valve and its association with the severity of aortic stenosis, aortic regurgitation, ascending aortic dilation, and associated anomalies.

Articles in Press

Document Type : Original Article

Authors

1 vascular and endovascular surgery research center, Mashhad university of medical science,

2 department of cardiology, mashhad university of medical science, ghaem hospital

3 mashhad university of medical science

10.22038/jctm.2025.86765.1488

Abstract

Background:

The bicuspid aortic valve (BAV) is the most common congenital cardiac anomaly. The abnormal bicuspid morphology of the aortic valve leads to valvular dysfunction and aortopathy. However, the clinical presentations of BAV are quite heterogeneous with variable valvular dysfunction and abnormalities. We aim to study the correlations between degrees of aortic stenosis and insufficiency, ascending aorta dilation and associated anomalies in different BAV phenotypes in our local population.

Method:

This cross-sectional study included 141 patients with a diagnosis of bicuspid aortic valve (BAV) who were referred for echocardiography prior to cardiac surgery. The BAV phenotype was classified into two types: anterior-posterior leaflet orientation (BAV-AP) and right-left leaflet orientation (BAV-RL). The study assessed aortic stenosis, insufficiency, and measured aortic dimensions at various locations. The mean age of the patients was 34 years, with a male-to-female ratio of 3:1. BAV-AP was found in 56.7% of patients, while BAV-RL was present in 43.3%. No significant differences in age, sex prevalence, or patterns of valvular dysfunction were observed between the two phenotypes, with moderate-to-severe aortic insufficiency being the most common finding (60% in BAV-AP vs. 57.4% in BAV-RL). However, aortic diameters were larger in the BAV-AP group at the sinuses of Valsalva (3.49 cm vs. 3.27 cm; p=0.039), and ascending aorta dilation was more prevalent in BAV-AP patients (60.8% vs. 43.1%; p=0.043). The most common associated cardiac anomalies were patent foramen ovale (8.5%) and aortic coarctation (7.1%).

Conclusion:

This study shows that moderate-to-severe AI is the most common valvular dysfunction in BAV patients, which is one of the independent risk factor for cardiac event in this patient; however, the pattern of valvular dysfunction is not different according to BAV phenotype. BAV-AP is associated with larger sinuses of Valsalva and more prevalent ascending aorta dilation, suggesting the possibility of different hemodynamic derangements or etiological entities between two types of BAV.

Keywords

Journal of Cardio-Thoracic Medicine

Articles in Press, Accepted Manuscript
Available Online from 03 April 2025

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