Key result
In 242 patients with bicuspid aortic valves, cardiovascular magnetic resonance identified aortic stenosis in 51%, aortic regurgitation in 17%, and aortic dilation in 39%.
This editorial highlights the utility of CMR in characterizing the heterogeneous phenotypic expression of bicuspid aortic valve syndrome, while noting methodological limitations in 2D vs 3D measurements.
A bicuspid aortic valve is the most common congenital heart defect in adults. The defect often has a heterogeneous phenotypic expression involving the heart as well as the vasculature; the constellation of pathologies has recently been termed the bicuspid aortic valve syndrome.1 Common components of the syndrome include aortic valve stenosis or regurgitation, aortic root or ascending aortic dilation, and aortic coarctation. Other associations of a bicuspid aortic valve include patent ductus arteriosus, supravalvular aortic stenosis (Williams syndrome), ventricular septal defect, and congenital coronary anomalies.2 The expression of these defects varies significantly and can only be characterized with the use of cardiovascular imaging. While echocardiography has been the traditional modality used for the imaging of patients with bicuspid aortic valves, cardiovascular magnetic resonance (CMR) has, in the last decade, emerged as a powerful modality for these patients. Wassmuth et al.3 present their experience with CMR in 242 patients with a bicuspid aortic valve. They describe the valvular and vascular features of the bicuspid aortic valve syndrome, noting a 51% frequency of aortic stenosis without regurgitation, a 17% frequency of aortic regurgitation without stenosis, and a 9% frequency of both aortic stenosis and regurgitation. Aortic dilation was noted in 39% of the patients, with the ascending aorta being the level that was most dilated. It is noteworthy that only 35% of the study cohort had 3-dimensional (3D) CMR angiography, and aortic dimensions were measured from axial localizer images in the other 65%. Measurements from 2D axial images may overestimate the size of an obliquely oriented or tortuous aorta.4 Nevertheless, the authors have to be commended for their efforts in collecting aortic dimensions in a relatively large number of patients and in highlighting the utility of CMR in the evaluation of the bicuspid aortic valve syndrome. Additional data that would have raised the impact of this paper include comparisons between CMR and echocardiography to demonstrate the incremental value of CMR, and correlations with haemodynamic data derived from CMR and/or echocardiography.
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Shenoy et al. (2014) conducted an editorial in Bicuspid aortic valve syndrome (n=242). Cardiovascular magnetic resonance (CMR) was evaluated on Frequency of valvular and vascular features. In 242 patients with bicuspid aortic valves, cardiovascular magnetic resonance identified aortic stenosis in 51%, aortic regurgitation in 17%, and aortic dilation in 39%.