Coronary Artery Anomalies: A New Facet of Bicuspid Aortic Valve?

pp 182-189

Abstract

Background: Bicuspid aortic valve (BAV) is conceived as a valvuloaortopathy, but its association with coronary artery anomalies has not been deeply investigated.

Objective: The aim of this study was to identify the association between coronary artery anomalies and BAV in adult patients using transthoracic echocardiography (TTE) and cardiac computed tomography (CCT) scan compared with patients with tricuspid aortic valve (TAV).

Methods: Consecutive patients with BAV undergoing CCT scan between 2018 and 2019 were analyzed and compared with patients with TAV matched for age and gender. All patients underwent TTE. Aortic diameters, aortic valve calcium score and coronary calcium score were estimated and the presence of fibrosis of the aortic valve was evaluated.

Results: A total of 87 patients were included in the study (42 in the BAV group and 45 controls with TAV). Mean age was 46.8 ± 16.8 years and 74.7% were men. Coronary artery anomalies were identified by CCT scan in 11 patients (26.1%) with BAV and in 1 patient with TAV (2.2%), p = 0.001. High take-off of the left main coronary artery from the ascending aorta was the most common anomaly (4 cases). Two patients presented interarterial course. High take-off was not associated with greater aortic root diameters.

Conclusions: Coronary artery anomalies were mostly benign and more common in patients with BAV than with TAV. Their correct diagnosis is important to achieve an adequate surgical planning.