Cardiac indexes in young subjects with and without bicuspid aortic valve

Bicuspid aortic valve (BAV) is a common congenital anomaly. The aeromedical implications of this condition are unclear. This study attempts to evaluate a possible association between BAV with or without aortic regurgitation (AR) and cardiac and aortic morphology in young healthy subjects.

Air force academy applicants undergo routine echocardiography as part of the screening process. All echocardiographic examinations performed in the years 2004-2011 were evaluated. Applicants in whom BAV was identified were divided into those with and without aortic regurgitation. Both groups were compared with an age-matched group of applicants in whom echocardiography was interpreted as normal. All M-mode parameters were compared between the three groups.

There were 7042 echocardiographic examinations performed in the years 2004-2010 and 95 applicants (1.35%) were diagnosed with BAV. Of these, 34 applicants had AR (36%) and 61 had no AR. When compared with normal subjects, systolic blood pressure was higher in applicants with BAV (127 mmHg vs. 123 mmHg, P = 0.01). Aortic root diameter, left atrial diameter, left ventricular end systolic volume, interventricular septum thickness and posterior wall thickness were all increased in applicants with BAV compared with applicants without BAV. In those with BAV, no statistically significant differences in M-mode characteristics were noted between applicants with and without aortic regurgitation.

BAV in young healthy subjects may influence cardiac morphology irrespective of the presence of aortic regurgitation. Aeromedical disposition for patients with BAV should be based on the presence of the condition and not on the presence of AR, considering the AR is of a mild or minimal degree.