title: Bicuspid aortic valves are associated with aortic dilatation out of proportion to coexistent valvular lesions.
abstract: BACKGROUND
  Bicuspid aortic valves (BAVs) are associated with premature valve stenosis, regurgitation, and ascending aortic aneurysms. We compared aortic size in BAV patients with aortic size in control patients with matched valvular lesions (aortic regurgitation, aortic stenosis, or mixed lesions) to determine whether intrinsic aortic abnormalities in BAVs account for aortic dilatation beyond that caused by valvular hemodynamic derangement alone.
  
  
  RESULTS
  Diameters of the left ventricular outflow tract, sinus of Valsalva, sinotubular junction, and proximal aorta were measured from transthoracic echocardiograms in 118 consecutive BAV patients. Annular area was 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, multivariate 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), despite advanced age in the control patients.
  
  
  CONCLUSIONS
  Aortic dimensions are larger in BAV patients than in control patients with comparable degrees of tricuspid aortic valve disease. Although more severe degrees of aortic regurgitation are associated with aortic dilatation in BAV patients, intrinsic pathology appears to be responsible for aortic enlargement beyond that predicted by hemodynamic factors.
authors.affiliation: Cardiovascular Division, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, USA.
authors.forename: M G
authors.initials: MG
authors.lastname: Keane
authors.forename: S E
authors.initials: SE
authors.lastname: Wiegers
authors.forename: T
authors.initials: T
authors.lastname: Plappert
authors.forename: A
authors.initials: A
authors.lastname: Pochettino
authors.forename: J E
authors.initials: JE
authors.lastname: Bavaria
authors.forename: M G
authors.initials: MG
authors.lastname: Sutton
mesh_terms: D000328:Adult; D017677:Age Distribution; D001011:Aorta / Q000000981:diagnostic imaging / Q000473:pathology*; D001021:Aortic Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000503:physiopathology; D001022:Aortic Valve Insufficiency / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D001830:Body Surface Area; D003710:Demography; D004108:Dilatation, Pathologic / Q000175:diagnosis / Q000209:etiology*; D004452:Echocardiography; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D017678:Sex Distribution; D014654:Vascular Patency