A retrospective analysis of mitral valve pathology in the setting of bicuspid aortic valves

Annari van Rensburg, Philip Herbst, Anton Doubell

The therapeutic implications of bicuspid aortic valve associations have come under scrutiny in the transcatheter aortic valve implantation era. We evaluate the spectrum of mitral valve disease in patients with bicuspid aortic valves to determine the need for closer echocardiographic scrutiny/follow-up of the mitral valve. A retrospective analysis of echocardiograms done at a referral hospital over five years was conducted in patients with bicuspid aortic valves with special attention to congenital abnormalities of the mitral valve. 140 patients with a bicuspid aortic valve were included. A congenital mitral valve abnormality was present in 8 (5.7%, p=0.01) with a parachute mitral valve in 4 (2.8%), an accessory mitral valve leaflet in 1 (0.7%), mitral valve prolapse in one, a cleft in one and the novel finding of a trileaflet mitral valve in one. Minor abnormalities included an elongated anterior mitral valve leaflet (p<0.001), the increased incidence of physiological mitral regurgitation (p=<0.001), abnormal papillary muscles (p=0.002) and an additional chord or tendon in the left ventricle cavity (p=0.007). Mitral valve abnormalities occur more commonly in patients with bicuspid aortic valves than matched healthy individuals. The study confirms that abnormalities in these patients extend beyond the aorta. These abnormalities did not have a significant functional effect.