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Retrospective study to identify predictors of the presence and rapid progression of aortic dilatation in patients with bicuspid aortic valves


Background Aortic dilatation is common among adults with bicuspid aortic valves (BAV). Predictors of risk and progression of aortic dilatation are not well described in this setting.

Methods We analyzed retrospective data on the presence of dilation in several aortic segments in 156 adult patients with BAV who had serial echocardiograms performed at least 1 year apart. Various risk factors for the presence and progression of aortic dilatation were identified.

Results Mean echocardiographic follow-up was 3.8 ± 1.4 years, yielding a total of 582 patient-years. Independent predictors of having a dilated aorta at baseline were age (odds ratio [OR] 1.06, 95% CI 1.03–1.09), body surface area (OR 8.78, 95% CI 1.08–71.70) and moderate to severe aortic regurgitation (OR 6.38, 95% CI 2.51–16.20). During echocardiographic follow-up, 16 (15.2%) patients developed dilatation (incidence 4 cases per 100 patientyears). Mean annual rates of progression were estimated at 0.37 mm (95% CI 0.17–0.57), 0.18 mm (95% CI 0.05–0.31), 0.17 mm (95% CI 0.06–0.29) and 0.18 mm (95% CI 0.05–0.31) for the ascending aorta, sinotubular junction, aortic sinus and aortic annulus, respectively. Fusion of the right and left valve leaflets was associated with rapid aortic dilatation (OR 2.92, 95% CI 1.15– 7.41) whereas prior coarctation repair was associated with protection from rapid aortic dilatation (OR 0.13, 95% CI 0.04–0.40).

Conclusions Patients with BAV and increased age, high body surface area and moderate to severe aortic regurgitation are more likely to have a dilated aorta. Patients with right-to-left leaflet fusion are at increased risk of rapid aortic dilatation.

Key Points

  • The incidence of aortic dilatation among adults with bicuspid aortic valves (BAV) is 4 cases per 100 patient-years

  • Increased age, high body surface area and aortic regurgitation predict the presence of a dilated aorta among adults with BAV

  • In patients with BAV, the mean rate of aortic dilatation is highest at the proximal ascending aorta (0.37 mm per year)

  • Patients with BAV and prior coarctation repair are those least likely to have rapidly progressive dilatation at the ascending aorta

  • Patients with BAV and fusion of the right and left valve leaflets are at high risk of rapid progression of aortic dilatation at the level of the ascending aorta and might benefit from close surveillance

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Figure 1: Flow chart of study participants.


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Correspondence to George Thanassoulis.

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Thanassoulis, G., Yip, J., Filion, K. et al. Retrospective study to identify predictors of the presence and rapid progression of aortic dilatation in patients with bicuspid aortic valves. Nat Rev Cardiol 5, 821–828 (2008).

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