title: Cardiac magnetic resonance imaging is more diagnostic than 2-dimensional echocardiography in determining the presence of bicuspid aortic valve.
abstract: OBJECTIVE
  This study compares 2-dimensional, transthoracic echocardiography with cardiac magnetic resonance imaging in the preoperative identification of bicuspid aortic valve before aortic valve surgery.
  
  
  METHODS
  Of 1203 patients who underwent an aortic valve operation, 218 had both preoperative transthoracic echocardiography and cardiac magnetic resonance imaging. Patients in the study group were aged 56 years and had an ejection fraction of 56%, 76% were male, and 29% had associated coronary artery disease. The results of transthoracic echocardiography and cardiac magnetic resonance imaging were classified as bicuspid aortic valve, trileaflet aortic valve, or nondiagnostic. Of the 218 patients, 123 (56%) had bicuspid aortic valve as determined at the time of surgery and 116 (53%) had an ascending aortic aneurysm.
  
  
  RESULTS
  Of the 123 patients with bicuspid aortic valve confirmed at surgery, by transthoracic echocardiography 76 (62%) were identified preoperatively with bicuspid aortic valve, 12 (10%) were misidentified with trileaflet aortic valve, and 35 (28%) were nondiagnostic for valve morphology. In the same patients with bicuspid aortic valve, by cardiac magnetic resonance imaging 115 (93%) were identified with bicuspid aortic valve, 5 (4%) were misidentified with trileaflet aortic valve, and 3 (2%) were nondiagnostic. The difference between transthoracic echocardiography and cardiac magnetic resonance imaging to determine the presence of bicuspid aortic valve was statistically significant (P<.001). In the entire cohort of patients, transthoracic echocardiography was diagnostic for valve morphology in 155 patients (71%) compared with cardiac magnetic resonance imaging, which was diagnostic in 212 patients (97%) (P<.001).
  
  
  CONCLUSIONS
  Cardiac magnetic resonance imaging is more diagnostic than transthoracic echocardiography in determining the presence of bicuspid aortic valve. A significant factor is the rate of nondiagnostic transthoracic echocardiography for aortic valve morphology. Cardiac magnetic resonance imaging can be performed as a complementary test when transthoracic echocardiography is nondiagnostic for aortic valve morphology.
authors.affiliation: Division of Cardiac Surgery, Department of Radiology, Northwestern University, Feinberg School of Medicine, Bluhm Cardiovascular Institute at Northwestern Memorial Hospital, Chicago, IL 60614, USA. cmalaisr@nmh.org
authors.forename: S Chris
authors.initials: SC
authors.lastname: Malaisrie
authors.forename: James
authors.initials: J
authors.lastname: Carr
authors.forename: Issam
authors.initials: I
authors.lastname: Mikati
authors.forename: Vera
authors.initials: V
authors.lastname: Rigolin
authors.forename: Byron K
authors.initials: BK
authors.lastname: Yip
authors.forename: Brittany
authors.initials: B
authors.lastname: Lapin
authors.forename: Patrick M
authors.initials: PM
authors.lastname: McCarthy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D012189:Retrospective Studies; D014463:Ultrasonography; D055815:Young Adult