Abstract 10730: Patterns of Aortic Dilatation in Bicuspid Aortic Valve-Associated Aortopathy
BACKGROUND: Bicuspid aortic valves (BAV) are associated with aortopathy. Recent studies suggest that aortic dilatation is more likely to be seen with left/right coronary cusp fusion (Type I) compared to right/non-coronary cusp fusion (Type II). Results in the published literature, however, have been divergent.
METHODS: Aortic dimensions and BAV morphology were obtained retrospectively from archived cineloops of 581 consecutive BAV patients. Measurements were performed at the aortic root (annulus & sinus of Valsalva), and the tubular aorta (sinotubular junction & proximal ascending aorta). Patient demographics and other echocardiographic parameters were extracted from the database.
RESULTS: The study population was comprised of 71% Type I BAV (415 patients), and 26% Type II BAV (149 patients). Concomitant aortic coarctation was infrequent at 2%. Aortic dilatation was present in 27% of the population. Type I BAV was associated with increased dimensions at the sinus of Valsalva compared with Type II BAV (18 ± 4mm/m2 vs. 16 ± 4mm/m2, median ± IQR; p < 0.001). Aortic dilatation in Type I BAV (see Figure 1) involved the aortic root more commonly than Type II BAV (57% vs. 28%; p = 0.001). No difference in dimensions of the proximal ascending aorta or prevalence of dilatation of the tubular aorta was seen between BAV morphologies. Type I BAV was an independent predictor of aortic root dilatation (OR 3.84; 95% CI 1.27 - 11.6). Severe aortic stenosis (AS) was associated with increased dimensions at the proximal ascending aorta, but did not increase the risk of pathologic aortic dilatation.
CONCLUSION: Type I BAV is associated with greater dimensions and a greater likelihood of dilatation at the level of the aortic root. The aortic root is relatively spared in Type II BAV. Severe AS does not increase the risk of aortic dilatation. Individuals with different BAV morphology may require different frequency and modalities of aortopathy surveillance independent of valvular function.
- © 2011 by American Heart Association, Inc.