Correlation between congenital bicuspid aortic valve morphology with thoracic aortic dimensions - a retrospective analysis with cardiovascular magnetic resonance

Abstract

Background Congenital bicuspid aortic valve (BAV) is the commonest inherited cardiac defect that is often associated with a medley of other cardiovascular anomaly, the most frequent being aortic dilatation which may be a consequent of an interplay between genetic and hemodynamic factors. This retrospective study aims to find a correlation between BAV valve morphology with thoracic aortic dimension with cardiovascular magenetic resonance imaging (CMR). Methods A retrospective analysis of the aortic valve and aortic (Ao) dimension was made of 149 patients aged between 6 and 77 years (mean age 43±17 ,102 males and 47 females) with BAV who underwent CMR study. BAV patients with associated coarctation or valvular dysfunction were excluded. Images were acquired with either a Siemens Avanto or Sonata 1.5T scanner in orthogonal planes. Aortic maximal intraluminal dimensions in end diastole were measured at the annulus, sinuses, sino-tubular junction, mid ascending aorta, arch and proximal descending aorta. These measurements were indexed according to body surface area (BSA). BAV valve morphology were characterised in cross-sectional steadystate free precession (SSFP) cine images and grouped according to the presence or absence of a raphe. Results Of the valve morphology, majority of patients (59.7%) had a raphe, almost always seen between the fused right and left cusps (89%). The indexed aortic root and ascending aortic dimensions were found to be smaller in patients with remnant raphe BAV as compared with those without a raphe (‘pure’ BAV). There was a trend towards smaller