Dilatation of the aorta in pure, severe, bicuspid aortic valve stenosis

Background Aortic complications are more frequent after bicuspid aortic valve (BAV) replacement (AVR), than tricuspid aortic valve replacement. We studied the size of the proximal thoracic aorta in patients with BAV undergoing AVR for pure, severe aortic stenosis, looking for dilatation in comparison with patients with a matched tricuspid aortic valve (TAV) and normograms of aortic size. Methods Aortic root and ascending aortic diameter measurements were taken at 3 levels, from electrocardiographic-gated multidetector row computed tomograms, in 28 patients with pure, severe aortic stenosis before AVR. The patients were divided in 2 groups (BAV, n = 10; TAV, n = 18). Patients with greater than mild aortic regurgitation or who were scheduled for aortic root replacement were excluded. Results Although patients in the BAV group were younger (P <.0001) and less likely to have hypertension (P <.005), their aortic diameters were larger than those of patients in the TAV group at all levels measured (aortic sinus, 41.1 ± 8.1 mm vs 33.8 ± 3.3 mm; sino-tubular junction, 39.0 ± 7.8 mm vs 31.1 ± 3.8 mm; right pulmonary artery level, 42.8 ± 7.1 mm vs 33.7 ± 4.3 mm; P <.005 for all). Whereas 60% (6/10) of patients in the BAV group had ≥1 aortic diameter measurements greater than the 95th age-adjusted percentile, 0% (0/18) of patients in the TAV group did. Conclusions Patients with BAV undergoing AVR with pure, severe aortic stenosis commonly have moderate dilatation of the thoracic aorta, whereas matched patients with a TAV do not. This finding may contribute to the increased frequency of aortic complications seen in follow up of patients with a BAV after AVR.