Prevalence of aortic valve prolapse with bicuspid aortic valve and its relation to aortic regurgitation: A cross-sectional echocardiographic study

Although aortic valve prolapse (AVP) has been suggested as a cause of aortic regurgitation (AR) in patients with bicuspid aortic valves, neither the frequency of AVP nor its relation to AR in this setting has been defined. To assess these relations, 64 patients with bicuspid aortic valves diagnosed by 2-dimensional echocardiography and 20 normal subjects, similarly distributed according to age and sex, were studied. The presence and degree of AVP were defined using 3 quantitative terms: aortic valve prolapse distance (AVPD), area (AVPA) and volume (AVPV). Each was corrected (c) for patient size with reference to the diameter of the aorta at the level of insertion of the valve cusps. In normal subjects, the AVPD c averaged 0.09 ± 0.06 (range 0 to 0.16) and the AVPA c averaged 0.08 ± 0.06 cm (range 0 to 0.15). In patients with bicuspid aortic valves, the AVPD c averaged 0.26 ± 0.10 (range 0.11 to 0.59, p = 0.00005 vs normal subjects), whereas the AVPA c averaged 0.35 ± 0.17 cm (range 0.05 to 0.90, p = 0.00005 vs normal subjects). When the AVPD c criteria were used, 81% of the bicuspid valves were abnormal; when the AVPA c criteria were used, 87% were abnormal. The degree of prolapse defined by the AVPV c , which considers both cusp area and degree of apical displacement, was significantly greater for patients with bicuspid aortic valve with clinical AR than for those without (p = 0.008). However, because of the overlap between groups, there was no point at which this measure uniquely separated patients with and without AR. There was no relation between the degree of prolapse and either age or degree of cusp asymmetry. The degree of AVP was greater in bicuspid valves with vertical vs those with horizontal commissures. AVP, therefore, occurs often in patients with bicuspid aortic valves; however, neither the presence nor the degree of AVP can be used to predict clinical AR.