The Role of Bicuspid Aortic Valve in Aortic Aneurysm Occurrence and Development

The paper presents the data on the diagnosis of bicuspid aortic valve (BAV) disease in the patients operated for ascending aortic (AA) aneurysm. A brief historical review of the study of the BAV problem is presented; the data on the BAV incidence in the development of ascending aortic aneurysm and its dissection, the results of surgical treatment of BAV disease in patients with AA aneurysm are displayed. The objective of the research was to study the role of the bicuspid aortic valve in the occurrence (dissection) of ascending aortic aneurysms. Materials and methods The retrospective analysis of the patients operated at the institute during the period of 1.01.2013 to 1.01.2019 for ascending aortic aneurysm or aneurysms of both ascending aorta and aortic arch confirmed that aneurysm occurrence (dissection) was caused by the presence of bicuspid valve. During this time, 1120 patients were operated on for ascending aortic aneurysm or aneurysms of both ascending aorta and aortic arch. 340 (30.4%) patients with diagnosed and confirmed BAV disease were included in the analysis. BAV diagnosis was based on echocardiography with obligatory intraoperative confirmation and on the basis of histological examination. Histological examination of the fragments of the aortic wall and aortic valve taken during operations was performed in 68 (20.0%) patients. Results and discussion BAV is the most common of all cardiac failures with a prevalence of up to 2% in the population constituting up to 30-50% of cases among the patients with aortal disorders. Two-dimensional echocardiography gives better results and provides an opportunity to detect BAV in 95% of cases, which was confirmed by our studies. According to our research, cases with BAV included 30.4% of all possible aneurysm causes, and BAV as a cause of dissection was noted in 46 (13.5%) of all dissecting aneurysms. Regarding the results of the surgical treatment, 2 patients out of 340 operated at the hospital stage died constituting 0.6%. Conclusions Among all ascending aortic aneurysms or aneurysms of both ascending aorta and aortic arch, BAV was determined as their cause in 30.4% of cases. Dissection (rupture) of the aortic aneurysm occurred in 13.5% of patients with aneurysm and bicuspid valve and thus required an urgent surgery.  Patients with BAV require lifelong care.