Long‐term performance of bicuspid and quadricuspid aortic valves: Similarities and differences

While bicuspid aortic valve (BAV) is a common congenital cardiac anomaly, quadricuspid aortic valve (QAV) is rare. The usual three‐leaflet aortic valve is characterized by engineering advantages with superior long‐term performance, and thus, degenerative changes and significant functional deterioration appear at advanced age. Aim: Evaluation of long‐term performance, similarities, and differences between QAV and BAV. Methods: Screening of 19 000 consecutive echocardiographic studies was performed. Results: BAV was reported in 131 subjects with a prevalence of 0.7%, while QAV was seen in 11 with a prevalence of 0.06%, P  < .00001. Age of BAV patients was younger, 45 ± 20 years vs 62 ± 17 years in QAV, P  < .05, with higher proportion of females in those with QAV, 40% vs 30%. Chamber diameters were similar in both groups. Higher atrial contraction‐A‐wave mitral peak velocities and longer E‐wave deceleration times were found in subjects with QAV, P  < .05 for both. Dilated ascending aorta was found in 25% of patients with BAV and in 18% of those with QAV, P  = .2. Moderate and severe aortic valve stenosis were found in 21% of patients with BAV and in 27% of those with QAV, P  = ns. More than moderate aortic regurgitation was found in 15.5% of BAV patients and in 9% of QAV, P  = ns. Aortic valve infective endocarditis was found in 1.5% of BAV patients and in 9% of those with QAV. Conclusions: BAV is a common congenital anomaly, while QAV is rare. Similar prevalence of significant valve disease and aortopathy was found in both anomalies, though at younger age in BAV patients.