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You are here: Contents > 2014 > Volume 23 Number 4 July 2014 > AORTIC VALVE DISEASE > Aortic Dilation Rates in Patients with Biscuspid Aortic Valve: Correlations with Cusp Fusion Phenotype

Aortic Dilation Rates in Patients with Biscuspid Aortic Valve: Correlations with Cusp Fusion Phenotype

Maude Pagé1, François-Pierre Mongeon1,3, Louis-Mathieu Stevens2, Vicky Soulière4, Paul Khairy1,3, Ismail El-Hamamsy5

1Division of Non Invasive Cardiology, Department of Medicine, Montreal Heart Institute, Université de Montreal, 2Division of Adult Congenital Heart Disease Center, Department of Medicine, Montreal Heart Institute, Université de Montréal, 3Division of Cardiac Surgery, Centre Hospitalier Universitaire de Montréal, Université de Montreal, 4Division of Cardiology, Department of Medicine, Hôpital du Sacré-Coeur de Montréal, Université de Montreal, 5Division of Cardiac Surgery, Montreal Heart Institute, Université de Montreal, Canada

Background and aim of the study: The study aim was to compare the pattern and rate of aortic dilation in patients with isolated non-surgical bicuspid aortic valve (BAV) with left-right fusion (L-R) and right non coronary fusion (R-N). Although the etiology and optimal management of aortic dilation associated with BAV remain the subject of debate, recent data have suggested that L-R and R-N cusp fusion phenotypes represent distinct pathological entities.

Methods: Consecutive patients with BAV and at least two echocardiographic assessments made between 2006 and 2012 were reviewed. Patients with hemodynamically significant valvular disease, aortic aneurysm (>50 mm) or unrepaired aortic coarctation were excluded. Longitudinal analyses of the aortic annulus, sinuses of Valsalva, sinotubular junction and ascending aortic diameters were performed using mixed-effect models.

Results: A total of 590 echocardiographic studies was analyzed in 212 patients (mean age 33 ± 14 years), of which 147 had L-R phenotype and 65 had R-N phenotype. The median follow up was 3.6 years. Baseline aortic diameters at the sinuses of Valsalva were larger in patients with L-R compared to R-N fusion (33.8 ± 5.3 mm versus 30.8 ± 4.8 mm; p <0.001). At this level, the rate of aortic dilation was higher with L-R versus R-N fusion (0.41 ± 0.11 mm/year versus 0.01 ± 0.08 mm/year; p <0.001). The rate of proximal ascending aortic dilation was also higher with L-R versus R-N fusion (0.58 ± 0.08 mm/year versus 0.18 ± 0.09 mm/year; p <0.001).

Conclusion: Aortic dilation rates vary according to the pattern of BAV cusp fusion, with faster rates of aortic sinus and ascending aortic dilation associated with the L-R compared to R-N phenotype.

The Journal of Heart Valve Disease 2014;23:450-457


Aortic Dilation Rates in Patients with Biscuspid Aortic Valve: Correlations with Cusp Fusion Phenotype

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