Abstract 11355: Cusp Fusion Phenotype is a Determinant of Ascending Aorta Dilation Rate and Pattern Among Patients with Isolated Bicuspid Aortic Valve
Background:Bicuspid aortic valves (BAV) are associated with aortic dilation. Recent data suggest that the 2 most common cusp fusion phenotypes (left-right [L-R] and right-non coronary [R-N]) represent distinct pathological entities. The aim of this study was to compare the pattern and rate of aortic dilation between cusp fusion phenotypes in subjects with functional BAVs.
Methods: From 2006-2012, all echocardiographic evaluations of BAVs performed at our institution were reviewed. Patients with <2 echocardiograms, significant valvulopathy (mean gradient >30mmHg and/or aortic regurgitation >1/4), aortic aneurysms (>50mm) or aortic coarctation were excluded. All examinations were individually reviewed and inner edge to inner edge diameters measured at the annulus, sinus of Valsalva, sinotubular junction (STJ) and ascending aorta. Longitudinal analysis of measurements was performed using mixed-effect models.
Results: A total of 612 echocardiographic studies were analyzed in 221 patients (n=154 L-R patients and n=67 R-N patients). Median follow-up was 3.6 years. Median age was similar in both groups (31 years; range 17-81 years). Baseline aortic root diameters were similar at all levels except at the sinuses of Valsalva (34.2 ± 5.7mm in L-R vs 31.1 ± 5.1mm in R-N patients;). The rate of dilation was significantly higher among L-R than R-N patients at the ascending aorta (0.57 ± 0.11mm/year vs 0.16 ± 0.08mm/year; p=0.003) and the sinuses of Valsalva (0.41 ± 0.13mm/year in L-R vs 0.09 ± 0.11mm/year in R-N; p=0.018; Figure 1). These differences persisted when adjusted to body surface area. No differences in dilation rate were observed at the annulus or STJ.
Conclusion: BAV patients present distinct aortic dilation patterns according to cusp fusion phenotype. In addition, patients with L-R fusion phenotype show faster sinus of Valsalva and ascending aorta dilation rates. The correlation with the risk of acute aortic events remains to be determined. Figure 1.
- © 2012 by American Heart Association, Inc.