Bicuspid aortic valve phenotype relationship with aortic root morphology and elasticity

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Background: Bicuspid Aortic Valve (BAV) affects about 0.5% to 2% of the population and predisposes patients to aortic stenosis or aortic dilation and dissection. Aortic size, morphology and elastic properties are thought to be related to BAV phenotype. Methods: In this retrospective study of 88 consecutive patients with BAV referred for transesophageal echocardiography, we aimed to determine aortic size, aortic root morphology and elastic properties. Distensibility, strain and stiffness index were calculated using cuff blood pressure in 37 patients without aortic stenosis or regurtiation. Results: Mean age of the patients was 40.3 years and 64 (72,7%) were men. We detected 51 (58%) patients with type 1 (right–left leaflet orientation), 10 (11, 3%) patients with type 2 (right-noncoronary leaflet orientation), 3 (3,4%) patients with type 3 (left –noncoronary leaflet orientation) and 24 (27,3%) patients without raphe. Among 51 patients with type 1 BAV with raphe 31 (60,8%) had type A (assendan aorta size>sinus of Valsalva size> sinotubulary junction size), 18 (35,3%) had type N (assendan aorta size≤sinus of Valsalva size > sinotubulary junction size) and 2 (3,9%) had type E (sinus of Valsalva size≤ sinotubulary junction size) aortic root morphology. Thirteen BAV patients without raphe (54,2%) had type A, 8 (33,3%) had type N and 3 (12,5%) had type E aortic root morphology. Type 2 BAV patients with raphe either had type N [5 (50%)] or type A [5 (50%)] aortic root morphology. Among patients with type 3 BAV with raphe 2 (66,7%) patients had type A, 1 (33,3%) had type N aortic root morphology. Aortic strain (AS), distensibility (D) were significantly higher and stiffness index (SI) was significantly lower in BAV with raphe compared to patients without raphe: AS: 7,39±2,9, D: 4,13±2, SI: 6,77±4,4 versus AS: 5,57±2,3, D: 2,77±1, SI: 8,04±3,1; p<0,05 for all parametres. There was no difference between root type A and root type N morphology as regards elasticity. Aortic distensibility and strain were negatively correlated with age and a positive correlation was detected between age and aortic root size. Conclusion: Our study showed no relation between aortic valve morphology and the aortic root shape. The finding of lower aortic distensibility in BAV patients without raphe may imply earlier aortic size increase predisposing to complications which must be investigated with further long term studies.

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