Different calcification patterns of tricuspid and bicuspid aortic valves and their clinical impact.

OBJECTIVES: Mechanical strain plays a major role in the development of aortic calcification. We hypothesized that (a) valvular calcifications are most pronounced at the localizations subjected to the highest mechanical strain and (b) calcification patterns are different in patients with bicuspid and tricuspid aortic valves.

METHODS: Multi slice computed tomography scans of 101 patients with severe aortic stenosis were analyzed using a 3D-post processing software to quantify calcification of tricuspid aortic valves (n = 51) and bicuspid aortic valves (n = 50) after matching.

RESULTS: BAV exhibited higher calcification volumes and increased calcification of the non-coronary cusp with significantly higher calcification of the free leaflet edge. The non-coronary cusp showed the highest calcium load compared to the other leaflets. Patients with annular calcification above the median had an impaired survival compared to patients with low annular calcification, whereas calcification of the free leaflet edge above the median did not (p = 0.53).

CONCLUSION: Calcification patterns are different in aortic stenosis patients with bicuspid and tricuspid aortic valves. Patients with high annular calcification might have an impaired prognosis.