Fetal echocardiographic features associated with bicuspid aortic valve

Area of Science:

• Cardiology
• Fetal Medicine
• Medical Imaging

Background:

• Prenatal diagnosis of bicuspid aortic valve (BAV) presents significant challenges.
• BAV is frequently associated with aortic dilation, complicating prenatal assessment.
• Accurate prenatal identification of BAV is crucial for timely intervention and management.

Purpose of the Study:

• To identify specific fetal echocardiographic features indicative of bicuspid aortic valve.
• To compare aortic dimensions and ratios in fetuses with and without confirmed BAV.
• To enhance prenatal detection rates for bicuspid aortic valve.

Main Methods:

• Retrospective analysis of fetal echocardiograms in fetuses with confirmed BAV and matched controls.
• Exclusion of cases with complex congenital heart lesions.
• Standardized measurements of the aortic valve, annulus, and aorta by blinded investigators.

Main Results:

• Fetuses with BAV exhibited smaller aortic annulus and root z-scores compared to controls.
• Significantly larger ratios of aortic root, sinotubular junction, ascending aorta, and transverse aorta to the aortic annulus were observed in BAV cases.
• Doming or thickened aortic valve leaflets were significantly more prevalent in fetuses with BAV.

Conclusions:

• Doming or thickened aortic valve leaflets on fetal echocardiogram are associated with BAV.
• Altered aortic dimension-to-annulus ratios in the presence of smaller aortic annulus sizes suggest potential for aortic dilation in fetuses with BAV.
• These echocardiographic findings can aid in increasing suspicion for BAV, guiding further investigation and postnatal follow-up.