Bicuspid aortic valves are associated with aortic dilatation out of proportion to coexistent valvular lesions

Background-Bicuspid aortic valves (BAVs) are associated with premature valv e stenosis, regurgitation, and ascending aortic aneurysms. We compared aort ic size in BAV patients with aortic size in control patients with matched v alvular lesions (aortic regurgitation, aortic stenosis, or mixed lesions) t o determine whether intrinsic aortic abnormalities in BAVs account for aort ic dilatation beyond that caused by valvular hemodynamic derangement alone. Methods and Results-Diameters of the left ventricular outflow tract, sinus of Valsalva, sinotubular junction, and proximal aorta were measured from tr ansthoracic echocardiograms in 118 consecutive BAV patients. Annular area w as measured by planimetry, and BAV eccentricity was expressed as the ratio of the right leaflet area to the total annular area. Seventy-seven control patients with tricuspid aortic valves were matched for sex and for combined severity of regurgitation and stenosis. BAV patients (79 men and 39 women, aged 44.1+/-15.5 years) had varying degrees of regurgitation (84 patients [71%]) and stenosis (48 patients [41%]). Within the bicuspid group, multiva riate analysis demonstrated that aortic diameters increased with worsening aortic regurgitation (P<0.001) and advancing age (P<0.05) but not with the severity of aortic stenosis. BAV patients had larger aortic diameters than did control patients at all ascending aortic levels measured (P<0.01), desp ite advanced age in the control patients. Conclusions-Aortic dimensions are larger in BAV patients than in control pa tients with comparable degrees of tricuspid aortic valve disease. Although more severe degrees of aortic regurgitation are associated with aortic dila tation in BAV patients, intrinsic pathology appears to be responsible for a ortic enlargement beyond that predicted by hemodynamic factors.