Aortic valve morphology definition with transthoracic combined with transesophageal echocardiography in a population with high prevalence of bicuspid aortic valve.

Objective: To assess the utility of transthoracic echocardiography (TTE) with second harmonic combined with transesophageal echocardiography (TEE) in defining aortic valve morphology in a subset of patients with a high prevalence of bicuspid aortic valve.

Methods And Materials: Patients (n = 174) with dilated aortic root were consecutively evaluated using, initially, TTE. The aortic valve structure was assigned as tricuspid, bicuspid or undefined. In those assigned as bicuspid or undefined, TEE was performed. Other factors that could affect valve morphology assignment were recorded and evaluated in multivariate analysis.

Results: TTE was able to characterise 89% of the tricuspid valves and 56% of the bicuspid. Bicuspid structure was the only variable that, in the multivariate analysis, was related to the inability to definitively assign aortic valve morphology (OR = 0.13). TEE was performed in 59 patients and the morphology was definitively assigned in 56 of them (95%). TEE diagnosed 15 bicuspid valves in addition to confirming the 17 identified by TTE. Overall, using TTE combined with TEE we were able to correctly assign valvular morphology in 98% of patients.

Conclusion: In a subset of patients with a high prevalence of bicuspid aortic valve, combination of TTE and TEE should be considered to define aortic valve morphology. TEE identifies an important number of patients with BAV.