Turk Kardiyol Dern Ars. 2017; 45(8): 690-701 | DOI: 10.5543/tkda.2017.03152
Assessment of bicuspid aortic valve phenotypes and associated pathologies: A transesophageal echocardiographic study
Selcen Yakar Tülüce1
, Kamil Tülüce2
, Ersin Çağrı Şimşek1
, Özgen Şafak1
, Mehmet Şefa Ökten3
, Zeynep Yapan Emren2
, Sadık Volkan Emren1
, Uğur Kocabaş1
, Serdar Bayata1
, Cem Nazlı11
Department of Cardiology, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey2
Department of Cardiology, Tepecik Training and Research Hospital, İzmir, Turkey3
Department of Cardiology, Ege University Faculty of Medicine, İzmir, Turkey
OBJECTIVE We investigated the frequency of different bicuspid aortic valve disease (BAV) phenotypes,the associated valvular pathologies, and the aortopathy phenotypes, using 2-dimensional (2D) transthoracic, 2D transesophageal echocardiography (TEE) and 3-dimensional (3D) TEE.
METHODS A total of 154 patients with BAV were included. Five BAV phenotypes were detected. To better define valvular pathologies, binary classifications of BAV were used: BAV with antero-posterior commisural line (BAV-AP) and right-left commissural line (BAV-RL). Aortopathy phenotype was classified according to the involved tract(s).
RESULTS Of the patients, 53.2% had type 1, 16.2% type 2, 15.6% type 3, 1.3% type 4, and 13.6% had type 5 BAV. The prevalence of BAV-AP and BAV-RL was 68.2% and 31.8%, respectively. No difference was detected with respect to aortic regurgitation between BAV-AP and BAV-RL (p=0.9), but the BAV-RL group had an increased propensity to have a stenotic aortic valve (p=0.003). The indexed aortic diameter was larger in BAV-AP cases than BAV-RL at the sinus of Valsalva (p=0.008). In patients with dilatation of the root and tubular portion, a predominance of BAV-AP versus BAV-RL was observed (85% vs 15%). A markedly low prevalence of the root phenotype (3.2%) was observed. In 90.1% of the patients, 2D TEE was sufficient to classify BAV phenotypes; further 3D imaging was needed in 9.9% of the cases.
CONCLUSION There may be racial differences in the frequency of valvular and aortopathy phenotypes in patients with BAV. BAV phenotypes differ with respect to aortic stenosis and aortopathy phenotypes. TEE may have good diagnostic utility in differentiating BAV phenotypes.
Aortopathy, bicuspid aortic valve; transesophageal echocardiography.
How to cite this article
Selcen Yakar Tülüce, Kamil Tülüce, Ersin Çağrı Şimşek, Özgen Şafak, Mehmet Şefa Ökten, Zeynep Yapan Emren, Sadık Volkan Emren, Uğur Kocabaş, Serdar Bayata, Cem Nazlı. Assessment of bicuspid aortic valve phenotypes and associated pathologies: A transesophageal echocardiographic study. Turk Kardiyol Dern Ars. 2017; 45(8): 690-701
Corresponding Author: Selcen Yakar Tülüce, Türkiye