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Bicuspid aortic valves (BAV) are frequently associated with dilation of the ascending aorta (AAo). Two opposing hypotheses advocate either an inborn connective tissue defect or dilation secondary to altered blood flow in the AAo. This study was initiated to evaluate flow patterns in the AAo of BAV patients compared to those in persons with tricuspid aortic valve (TAV) using four-dimensional cardiovascular magnetic resonance (CMR). 18 healthy individuals with normally functioning BAV were compared with an age and sex matched control group with tricuspid aortic valve (TAV). Classification of flow alterations was performed by three blinded observers concerning their intensity. Flow patterns in the matched pairs were significantly different (p=0.0004). This altered flow may have an important impact on the development of aortic dilation in patients with BAV. The connective tissue defect may only be a secondary finding in these patients.

Visualization of flow in the ascending aorta: bicuspid aortic valves compared to tricuspid aortic valves