Morphology of bicuspid aortic valve influences outcomes

Christiane Pees, M.D., and Ina Michel-Behnke, Ph.D., from the University Children's Hospital in Vienna, prospectively examined 48 pediatric patients with an isolated, native BAV and 48 matching subjects with tricuspid aortic valves for the morphology and size of the aortic valve, aortic root, sinotubular junction, and ascending aorta and their elasticity indexes.

The researchers found normal-size aortic dimensions in the tricuspid aortic valves, but in the BAVs, the ascending aorta and aortic valve itself dilated with age and aortic elasticity deteriorated. The stiffness was significantly greater in the BAVs (4.43 ± 1.82 versus 3.43 ± 0.81 in the tricuspid aortic valves). There was a significant inverse decrease in the distensibility indexes in the BAVs (6.57 ± 2.83 versus 7.84 ± 2.04 cm² × dynes⁻¹ × 10⁻⁶ and 53.5 ± 26.0 versus 64.3 ± 17.9 kPa⁻¹ × 10⁻³). Even after correction for congenital valve dysfunction, the anteroposterior-oriented phenotype of BAVs showed significantly stiffer and less distensible elasticity, which was more frequent in the left-right-oriented phenotype.

"In conclusion, the morphology of the BAV seems to play a major role in the outcome of BAV disease, although the left-right phenotype is more prone to congenital valve dysfunction, the anteroposterior phenotype showed worse elasticity quality," the authors write.

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Journal reference: American Journal of Cardiology

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