Bicuspid aortic valve phenotype relationship with aortic root morphology and elasticity

This study examines the potential links between bicuspid aortic valve (BAV) subtype, aortic root shape, and mechanical properties in a patient cohort.

We retrospectively analyzed 88 patients with BAV undergoing transesophageal echocardiography (TEE). Aortic dimensions and shapes were assessed in all participants, while mechanical properties (aortic strain, distensibility, and stiffness) were measured in 37 patients without significant valve dysfunction.

Among type 1 BAV with raphe (n = 51), 60.8% had type A aortic shape, 35.3% type N, and 3.9% type E. For BAV without raphe (n = 24), 54.2% had type A, 33.3% type N, and 12.5% type E. Type 2 (n = 10) and type 3 (n = 3) BAV showed varied aortic shapes without a clear pattern. Patients with raphe had superior aortic mechanics compared to those without, with higher strain (7.39 ± 2.9 vs. 5.57 ± 2.3), greater distensibility (4.13 ± 2.0 vs. 2.77 ± 1.0 cm²·dyne⁻¹·10⁻⁶), and lower stiffness (6.77 ± 4.4 vs. 8.04 ± 3.1) (p < 0.05 for all).

Aortic shape showed no significant association with BAV subtype. However, reduced distensibility in non-raphe BAV patients suggests a potential for earlier aortic complications, necessitating longitudinal studies.