The Role of Bicuspid Aortic Valve in the Evolution of Cardiovascular Complications

The most common congenital heart defect such as the bicuspid aortic valve is the most frequent morphological basis of aortopathy. Morphology of bicuspid aortic valve may have influence in the associated pathologies including aortic stenosis, aortic insufficiency and aortic dilation. The purpose of this study was to define the frequency and patterns of valvular dysfunction and aortopathy associated with different types of bicuspid aortic valve. Most cases of severe aortic failure are associated directly or indirectly with congenital bicuspid aortic valve. Material and methods. We analyzed clinical, instrumental, laboratory, instrumental, including echocardiography studies of 51 patients (33 men and 18 women) with diagnosed bicuspid aortic valve. All patients were referred for transesophageal echocardiography. Aortic valve value less than 0.05 was considered statistically significant. Frequency of various bicuspid aortic valve phenotypes and their association with valvular dysfunction and aortopathy was evaluated. Results and discussion. The analysis of the frequency of phenotypes detection showed the following addiction. A single suture bicuspid aortic valve, which is usually located between the left and right coronary cusps with hemodynamically prevailing stenosis, is more common, and all other types are defined as a mixed compound which is one of the risk factors for aortic stenosis and associated aortopathy and may lead to significant hemodynamic changes. Patients in the bicuspid aortic valve group were more likely to have periannular complications in compare with the tricuspid group. The prominent clinical manifestations brought on the progression of heart failure and the development of complications. The aortic pathology analysis is performed depending on the bicuspid aortic valve phenotype. The placement of the ventricles may be anterior-posterior or right-to-left. According to the functional state of the bicuspid aortic valve divided into complicated and uncomplicated. Patients of different phenotypes are characterized with indirect eccentric flow and uneven tension on the walls of the aorta that lead to vascular remodeling of the ascending aorta and formation of aneurysms or dissection. There was a significant difference in the frequency of aortic stenosis and failure of the aortic valve. The phenotype 3 showed a significantly higher incidence of aortic stenosis compared to phenotype 1, while the frequency of aortic failure in phenotype 1 was higher than among other phenotypes. The frequency of mass or vegetation in phenotype 1 was significantly lower compared to other phenotypes. Conclusions. Timely transesophageal echocardiography and diagnosis of initial conditions of hyalinosis, fibrosis and calcinosis of bicuspid aortic valve, insufficiency and stenosis of aortic valve or insufficiency of the aorta allows early delivery to surgical treatment to prevent hemodynamic dysfunction, to improve the quality and the increase patient's lifetime.