Association between bicuspid aortic valve morphotype and regional dilatation of the aortic root and trunk

Abstract

Thoracic aortic disease, including thoracic aor- tic aneurysm (TAA), is frequently seen in patients with bicuspid aortic valve (BAV). We hypothesized that BAV morphotype would be associated with aortic aneurysm phe- notypes but that other patient variables would signiicantly modify this relationship. 829 patients between 18 and 90 years with BAV and available raw imaging of the aortic valve and the ascending aorta to its mid-portion prior to aortic valve and aortic surgery were examined. The sinuses of Valsalva and proximal ascending aorta were measured from 2-dimensional co-planar echocardiographic images. We observed strong associations between patient habitus and raw and normalized dimensions of the aortic root and ascending aorta. Patients with R–L morphotype presented at an older age with larger aortic root but similar ascend- ing aortic dimensions. After accounting for patient mor- phometric characteristics and severity of aortic valve dis- ease, patients with R–L valve morphotype were marginally more likely to have an aortic root aneurysm (86% vs. 78%; P=0.043), deined as aortic root dimension Z score ≥3 We observed only small diferences in aortic dimensions between BAV morphotypes, that are eclipsed by variation in patient habitus. We interpret these indings to mean that BAV patients will not likely beneit from therapies based on aortic valve morphotype. Rather, we propose that all BAV patients should undergo longitudinal follow-up, inde- pendent of valve morphotype. Guidelines for aortic surgery based upon dimensions alone may be improved by con- sidering patient characteristics such as age, body size and other characteristics.