Clinical InvestigationsEchocardiographic Assessment of the Aortic RootAortic Root Anatomy Is Related to the Bicuspid Aortic Valve Phenotype
Graphical abstract
Section snippets
Population
Consecutive patients referred to two tertiary centers (Centre de Référence pour le Syndrome de Marfan et syndromes apparentés, Hopital Bichat, Paris, France, and Institut Mutualiste Montsouris, Paris, France) for evaluation of thoracic aortic aneurysms, in whom Marfan syndrome (MFS) diagnosis has been excluded, who had BAV and underwent both TTE and electrocardiographically gated computed tomography (CT) for ascending aortic assessment, were included. Patients with significant aortic
Population
Eighty-four patients with BAV and without significant valvulopathy were included in the study. Characteristics of patients are summarized in Table 1. Patients were mostly men (74%), with a mean age of 43.7 ± 15.4 years. Sixty-three patients (74%) were found to have L-R BAV, and 22 (26%) had N-R BAV. The L-R BAV group included 52 patients with raphe and 11 patients without raphe, while the N-R BAV group included 12 patients with raphe and 10 patients without raphe. Approximately half of the
Discussion
Aortic root asymmetry in patients with BAV is already known,7,8 and it has led to difficulties in interpreting aortic root diameters in these patients, so that a recent panel of experts called for research and consensus on the phenotyping of BAV to help in resolving the gaps of knowledge in this field.9 In the present study, we show that there is a close relationship between the orientation of aortic valve opening (BAV phenotype) and the orientation of the maximal aortic root diameter in the
Conclusion
The aortic root is asymmetric in patients with BAV, and aortic root phenotype can be predicted from the valve opening orientation. Indeed, the largest root diameter is roughly perpendicular to the valve opening orientation. As a result, the largest aortic root diameter cannot be adequately measured in the PLAX view on TTE, as presently recommended in guidelines, when valve opening orientation is vertical. A simple BAV classification based on the valve opening orientation (i.e., horizontal vs
Acknowledgment
We wish to thank Natasha Barr for editing the manuscript.
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Cited by (3)
The unmet needs for aortic diameter determination in patients with aortopathies
2023, International Journal of CardiologyMechanisms of Aortic Dilation in Patients With Bicuspid Aortic Valve: JACC State-of-the-Art Review
2023, Journal of the American College of CardiologyA Comprehensive Review of Management Strategies for Bicuspid Aortic Valve (BAV): Exploring Epidemiology, Aetiology, Aortopathy, and Interventions in Light of Recent Guidelines
2023, Journal of Cardiovascular Development and Disease
Conflicts of interest: None.