Echocardiographic Evaluation Of Adult Bicuspid Aortic Valve Phenotype And Character

Objective:Bicuspid aortic valve (BAV) can be divided into Type I (Anterior-Posterior type, A-P type) and Type II (Left-Right type, L-R type) based on the fusion of leaflets. This study aimed to explore the difference of clinical and echocardiographic character between two types of adult patients with BAV.Methods:Clinical and echocardiographic data of 81 adult patients with BAV (63 males; 48 ±14years) admitted in PLA general hospital from November 2008 to June 2014 were retrospectively analyzed. The phenotype of the aortic valve was evaluated and aortic dimension was measured using transthoracic echocardiography (TTE).Results:In 81 adult BAV patients, there were 29 patients with type I and 52 patients with type II. Baseline clinical character and left heart function were similar between two types. There was a higher incidence of moderate or severe aortic regurgitation (AR) and aortic sinus dilation in type I group than that in type II group (P<0.05). On the other hand, there was a higher incidence of moderate or severe aortic stenosis (AS) in type II group than that in type I (P<0.05). The incidence of ascending aorta dilation and aortic valve infective endocarditis (IE) were similar between the two groups (P>0.05). Patients in type I group have a larger aortic annulus, aortic sinus, and sino-tubular junction diameter (P<0.05). There is no significant difference in ascending aorta diameter between two groups (P=0.146).Conclusion:There is a male predominance in adult BAV patients and type II is more common. Type I patients, which have a higher incidence of moderate or severe AR, were associated with larger dimensions of aortic annulus, aortic sinus, and sino-tubular junction. But type II patients were prone to moderate or severe AS. These findings provide clues for the diagnose and treatment of different types of adult BAV patients in clinical practice.