Usefulness of Bicuspid Aortic Valve Phenotype to Predict Elastic Properties of the Ascending Aorta

Bicuspid aortic valve (BAV) affects about 0.5% to 2% of the population and predisposes patients to aortic dilation and dissection. We hypothesized that aortic size and elastic properties are related to BAV phenotype. In a retrospective study of 158 consecutive patients with BAV referred for echocardiography, the phenotype was defined as anterior–posterior (A–P) leaflet orientation or right–left (R–L) leaflet orientation. The 29 subjects with R–L BAV were matched 1:1 for age, gender, and grade of aortic valve dysfunction with 29 subjects with A–P BAV. Aortic dimensions were measured at the sinuses of Valsalva, ascending aorta, and aortic arch. Distensibility and stiffness index were calculated using cuff blood pressure. Mean age was 41.5 years (range 21 to 67), and 59% were men. Aortic diameter was larger with A–P BAV than R–L at the sinuses (mean ± 1 SD 3.48 ± 0.49 vs 3.06 ± 0.59, p <0 .01) and smaller at the arch (2.34 ± 0.40 vs 2.83 ± 0.45, p <0.001). At the sinuses, A–P BAV had a higher stiffness index (median 12.98, range 2.78 to 42.07 vs 6.41, range 2.75 to 59.72, p <0.01) and lower distensibility. Stiffness index in the ascending aorta and arch (but not at the sinus) increased with age. In conclusion, A–P BAV is associated with a larger stiffer sinus of Valsalva and smaller arch diameter. The potential impact of BAV phenotype and aortic elasticity on clinical outcomes merits further study.