P755Assessment of bicuspid aortic valve and its repercussion with cardiac magnetic resonance

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Bicuspid aortic valve (BAV) is the most frequent congenital cardiopathy. It is usually seen along with aortic valve dysfunction and ascending aorta dilatation. Our aim was to characterize, using cardiovascular magnetic resonance (CMR) the anatomy and cardiovascular repercussion of this anomaly in our population of patients submitted to CMR.Methods: All BAV patients studied with CMR in our unit within the last three years were included. CMR-1.5T protocol included functional sequences in the usual views, T1WTSE, vascular phase contrast and 3D-MR angiography, when necessary. The following information was obtained: a) aortic valve and ascending aorta anatomy and dimensions, b) assessment of aortic stenosis/regurgitation, c) left ventricular (LV) dimensions.Results: Between January 2008 and December 2010 2880 CMR scans were done. Of all, 57 patients had BAV (1.9%) (9 females, 50±19yrs). In 12 patients BAV was already known at the time of the study but in the remaining 45 it was a new CMR finding (reasons for referral: 25 myocardial perfusion studies, 4 congenital cardiopathies, 6 aortic dilatations, 10 valvular dysfunctions). The most frequent anatomic variant was fusion of both coronary valves (63%), followed by fusion of the right coronary valve with the non-coronary valve (21%) and fusion of the left coronary valve with the non-coronary valve (16%). Aortic regurgitation was present in 25 patients (44%, 6 severe and 5 moderate) while aortic stenosis was observed in another 12 (23%, 4 severe and 5 moderate). With respect to the ascending aorta, the annulus was dilated in 32% of patients, with a mean diameter for the whole group of 13±3mm/m2. The sinus was dilated in 51% of subjects, with a mean diameter of 21±4mm/m2. The sinotubular junction appeared dilated in 44% of cases, mean diameter of 18±4mm/m2. Lastly, the tubular portion of the ascending aorta was dilated in 72% of patients, with a mean diameter of 22±5mm/m2. The LV was found to be dilated in 21 patients, mainly in those with aortic regurgitation, and 36 subjects had LV hypertrophy, (22 eccentric and 14 concentric). LV systolic function was depressed in 9 patients, but mean LV ejection fraction was normal.Conclusions: In this descriptive study we found that VAB was present in 1.9% of our patients submitted to CMR. The most frequent anatomic variant was fusion of both coronary valves. There was a high incidence of aortic valve regurgitation and stenosis as well as dilatation at all levels of the ascending aorta.

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