The prediction of the risk of ascending aortic dilatation and aneurysm formation in bicuspid valve patients
The most frequent finding associated with the bicuspid aortic valve (BAV) is the dilatation of the proximal ascending aorta (AA) secondary to abnormalities of the aortic media. Changes in the aortic media are present independently of the valve functionality and, consequently, AA dimensions increase and the related aortic dissection seem not to be connected with hemodynamic abnormalities. However, the abnormal shear stress related to BAV leads to valve calcification, aortic incompetence, further aortic root and proximal AA dilatation. In addition, surprisingly Debl K et al (Clin Res Cardiol 2009, 98:114-120) pointed out that the aortic arch and descending aorta diameters were identical in subjects with BAV and tricuspid aortic valve. Therefore, a potential explanation of such finding might be that these aorta segments are subject to less hemodynamic stress as compared to AA which may not reach a threshold necessary for progressive dilatation. Understanding the progression of this complex disease will help to precisely define late survival, identify earlier high-risk groups, and improve timing of interventions.