Skip to main content
SpringerLink
Log in

Characteristics of aortic valve dysfunction and ascending aorta dimensions according to bicuspid aortic valve morphology

  • Cardiac
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To characterize aortic valve dysfunction and ascending aorta dimensions according to bicuspid aortic valve (BAV) morphology using computed tomography (CT) and surgical findings.

Methods

We retrospectively enrolled 209 patients with BAVs who underwent transthoracic echocardiography (TTE) and CT. BAVs were classified as anterior-posterior (BAV-AP) or lateral (BAV-LA) orientation of the cusps and divided according to the presence (raphe+) or absence (raphe–) of a raphe. Ascending aortic dimensions were measured by CT at four levels.

Results

BAV-AP was present in 129 patients (61.7 %) and raphe+ in 120 (57.4 %). Sixty-nine patients (33.0 %) had aortic regurgitation (AR), 70 (33.5 %) had aortic stenosis (AS), and 58 (27.8 %) had combined AS and AR. AR was more common in patients with BAV-AP and raphe+; AS was more common with BAV-LA and raphe–.Annulus/body surface area and tubular portion/body surface area diameters in patients with BAV-AP (17.1 ± 2.3 mm/m2 and 24.2 ± 5.3 mm/m2, respectively) and raphe+ (17.3 ± 2.2 mm/m2 and 24.2 ± 5.5 mm/m2, respectively) were significantly different from those with BAV-LA (15.8 ± 1.9 mm/m2 and 26.4 ± 5.5 mm/m2, respectively) and raphe– (15.7 ± 1.9 mm/m2 and 26.2 ± 5.4 mm/m2, respectively).

Conclusion

The morphological characteristics of BAV might be associated with the type of valvular dysfunction, and degree and location of an ascending aorta dilatation.

Key points

• The BAV-AP type had more frequent aortic regurgitation, raphe, and a larger aortic annulus.

• BAV without raphe had more frequent aortic stenosis and mid-ascending aorta dilatation.

• CT allows assessment of the morphological characteristics of BAV and associated aortopathy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

AA:

Ascending aorta

AR:

Aortic regurgitation

AS:

Aortic stenosis

ASR:

Aortic stenosis and regurgitation

BAV:

Bicuspid aortic valve

BPM:

Beats per minute

CCTA:

Coronary computed tomography angiography

CT:

Computed tomography

ECG:

Electrocardiography

HR:

Heart rate

MDCT:

Multidetector computed tomography

TAV:

Tricuspid aortic valve

TTE:

Transthoracic echocardiography

References

  1. Siu SC, Silversides CK (2010) Bicuspid aortic valve disease. J Am Coll Cardiol 55:2789–2800

    Article  PubMed  Google Scholar 

  2. Fernandes SM, Sanders SP, Khairy P et al (2004) Morphology of bicuspid aortic valve in children and adolescents. J Am Coll Cardiol 44:1648–1651

    Article  PubMed  Google Scholar 

  3. Jassal DS, Bhagirath KM, Tam JW et al (2010) Association of bicuspid aortic valve morphology and aortic root dimensions: a substudy of the aortic stenosis progression observation measuring effects of rosuvastatin (ASTRONOMER) study. Echocardiography 27:174–179

    Article  PubMed  Google Scholar 

  4. Alkadhi H, Leschka S, Trindade PT et al (2010) Cardiac CT for the differentiation of bicuspid and tricuspid valves: comparison with echocardiography and surgery. AJR Am J Roentgenol 195:900–908

    Article  PubMed  Google Scholar 

  5. Ocak I, Lacomis JM, Deible CR, Pealer K, Parag Y, Knollmann F (2009) The aortic root: comparison of measurements from ECG-gated CT angiography with transthoracic echocardiography. J Thorac Imaging 24:223–226

    Article  PubMed  Google Scholar 

  6. Feuchtner GM, Muller S, Bonatti J et al (2007) Sixty-four slice CT evaluation of aortic stenosis using planimetry of the aortic valve area. AJR Am J Roentgenol 189:197–203

    Article  PubMed  Google Scholar 

  7. Feuchtner GM, Dichtl W, Müller S et al (2008) 64-MDCT for diagnosis of aortic regurgitation in patients referred to CT coronary angiography. AJR Am J Roentgenol 191:W1–W7

    Article  PubMed  Google Scholar 

  8. Lee SC, Ko SM, Song MG, Shin JK, Chee HK, Hwang HK (2012) Morphological assessment of the aortic valve using coronary computed tomography angiography, cardiovascular magnetic resonance, and transthoracic echocardiography: comparison with intraoperative findings. Int J Cardiovasc Imaging 28:33–44

    Google Scholar 

  9. Joo I, Park EA, Kim KH et al (2012) MDCT differentiation between bicuspid and tricuspid aortic valves in patients with aortic valvular disease: correlation with surgical findings. Int J Cardiovasc Imaging 28:171–182

    Article  PubMed  Google Scholar 

  10. Tops LF, Wood DA, Delgado V et al (2008) Noninvasive evaluation of the aortic root with multislice computed tomography implication for transcatheter aortic valve replacement. J Am Coll Img 1:321–330

    Article  Google Scholar 

  11. Khoo C, Cheung C, Jue J (2013) Patterns of aortic dilatation in bicuspid aortic valve-associated aortopathy. J Am Soc Echocardiogr 26:600–605

    Article  PubMed  Google Scholar 

  12. Kang JW, Song HG, Yang DH et al (2013) Association between bicuspid aortic valve phenotype and patterns of valvular dysfunction and bicuspid aortopathy. J Am Coll Cardiol Img 6:150–161

    Article  Google Scholar 

  13. Bonow RO, Carabello BA, Chatterjee K et al (2008) 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 118:e523–e661

    Article  PubMed  Google Scholar 

  14. Song MG, Yang HS, Choi JB et al (2014) Aortic valve reconstruction with leaflet replacement and sinotubular junction fixation: early and midterm results. Ann Thorac Surg 97:1235–1241

    Article  PubMed  Google Scholar 

  15. Sievers HH, Schmidtke C (2007) A classification system for the bicuspid aortic valve from 304 surgical specimens. J Thorac Cardiovasc Surg 133:1226–1233

    Article  PubMed  Google Scholar 

  16. Russo CF, Cannata A, Lanfranconi M, Vitali E, Garatti A, Bonacina E (2008) Is aortic wall degeneration related to bicuspid aortic valve anatomy with valvular disease? J Thorac Cardiovasc Surg 136:937–942

    Article  PubMed  Google Scholar 

  17. Buchner S, Hulsmann M, Poschenrieder F et al (2010) Variable phenotypes of bicuspid aortic valve disease: classification by cardiovascular magnetic resonance. Heart 96:1233–1240

    Article  PubMed  Google Scholar 

  18. Schaefer BM, Lewin MB, Stout KK et al (2008) The bicuspid aortic valve: an integrated phenotypic classification of leaflet morphology and aortic root shape. Heart 94:1634–1638

    Article  CAS  PubMed  Google Scholar 

  19. Kari FA, Fazel SS, Mitchell RS, Fischbein MP, Miller DC (2012) Bicuspid aortic valve configuration and aortopathy pattern might represent different pathophysiologic substrates. J Thorac Cardiovasc Surg 144:516–517

    Article  PubMed  Google Scholar 

  20. Cecconi M, Manfrin M, Moraca A et al (2005) Aortic dimensions in patients with bicuspid aortic valve without significant valve dysfunction. Am J Cardiol 95:292–294

    Article  PubMed  Google Scholar 

  21. den Reijer PM, Sallee D 3rd, van der Velden P et al (2010) Hemodynamic predictors of aortic dilatation in bicuspid aortic valve by velocity-encoded cardiovascular magnetic resonance. J Cardiovasc Magn Reson 13:12–14

    Google Scholar 

  22. Bauer M, Siniawski H, Pasic M, Schaumann B, Hetzer R (2006) Different hemodynamic stress of the ascending aorta wall in patients with bicuspid and tricuspid aortic valve. J Card Surg 21:218–220

    Article  PubMed  Google Scholar 

  23. Hope MD, Hope TA, Meadows AK et al (2010) Bicuspid aortic valve: four-dimensional MR evaluation of ascending aortic systolic flow patterns. Radiology 255:53–61

    Article  PubMed  Google Scholar 

  24. Fedak PW, Verma S, David TE, Leask RL, Weisel RD, Butany J (2002) Clinical and pathophysiological implications of a bicuspid aortic valve. Circulation 106:900–904

    Article  PubMed  Google Scholar 

  25. Fedak PW, de Sa MP, Verma S et al (2003) Vascular matrix remodeling in patients with bicuspid aortic valve malformations: implications for aortic dilatation. J Thorac Cardiovasc Surg 126:797–806

    Article  PubMed  Google Scholar 

  26. Fernández B, Durán AC, Fernández-Gallego T et al (2009) Bicuspid aortic valves with different spatial orientations of the leaflets are distinct etiological entities. J Am Coll Cardiol 54:2312–2318

    Article  PubMed  Google Scholar 

  27. Grube E, Laborde JC, Gerckens U et al (2006) Percutaneous implantation of the CoreValve self-expanding valve prosthesis in high-risk patients with aortic valve disease: the Siegburg first-in-man study. Circulation 114:1616–1624

    Article  PubMed  Google Scholar 

  28. Webb JG, Chandavimol M, Thompson CR et al (2006) Percutaneous aortic valve implantation retrograde from the femoral artery. Circulation 113:842–850

    Article  PubMed  Google Scholar 

  29. Layritz C, Schmid J, Achenbach S et al (2014) Accuracy of prospectively ECG-triggered very low-dose coronary dual-source CT angiography using iterative reconstruction for the detection of coronary artery stenosis: comparison with invasive catheterization. Eur Heart J Cardiovasc Imaging 15:1238–1245

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The scientific guarantor of this publication is Je Kyon Shin, a tenured senior professor at the Konkuk University Medical Center. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This study has not received funding by any institute or companies. Hyo Jin Min kindly provided statistical advice for this manuscript. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.

Author information

Authors and Affiliations

  1. Department of Cardiovascular Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea

    Hong Ju Shin, Je Kyoun Shin, Hyun Kun Chee & Jun Suk Kim

  2. Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, 4-12 Hwayang-dong, Gwangjin-gu, Seoul, 143-729, Korea

    Sung Min Ko

  3. Department of Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea

    Hong Ju Shin

Authors
  1. Hong Ju Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Je Kyoun Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hyun Kun Chee
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jun Suk Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sung Min Ko
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sung Min Ko.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shin, H.J., Shin, J.K., Chee, H.K. et al. Characteristics of aortic valve dysfunction and ascending aorta dimensions according to bicuspid aortic valve morphology. Eur Radiol 25, 2103–2114 (2015). https://doi.org/10.1007/s00330-014-3585-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-014-3585-z

Keywords

Search

Navigation