Serial echocardiography for valve dysfunction and aortic dilation in bicuspid aortic valves.

Area of Science:

• Cardiology
• Echocardiography
• Valvular Heart Disease

Background:

• Bicuspid aortic valve (BAV) complications include aortic stenosis, regurgitation, and ascending aortic dilation.
• The natural history and progression of these BAV-related lesions are not well-defined.

Purpose of the Study:

• To investigate the progression of valvular dysfunction and aortic dilation in patients with bicuspid aortic valve.
• To compare the progression rates between different bicuspid aortic valve morphologies.

Main Methods:

• A retrospective review of 249 bicuspid aortic valve patients with serial echocardiograms (2006-2016).
• Valve morphology (right-left or right-noncoronary cusp fusion) was assessed.
• Annualized progression of aortic stenosis, regurgitation, and ascending aorta diameter was calculated and compared between groups using multivariable logistic regression.

Main Results:

• Among 249 patients, 75.9% had right-left cusp fusion. Mean annualized decrease in aortic valve area was 0.07 cm²/year.
• Aortic regurgitation progressed by at least one grade in 37 patients.
• Ascending aorta diameter increased annually by 0.36 mm/year in right-left and 0.65 mm/year in right-nonbicuspid valves.

Conclusions:

• Cusp orientation was not associated with the progression of aortic stenosis or regurgitation in bicuspid aortic valve patients.
• Right-noncoronary cusp fusion was significantly associated with accelerated progression of ascending aortic diameter.