Bicuspid Aortic Valve in Adult Patients: Accompanying Cardiovascular Pathology and Variations

Introduction: This study aimed to investigate the prevalence of aortic valve calcification, aortic dilatation, and coronary artery disease (CAD) in patients with bicuspid aortic valve (BAV) identified incidentally through coronary computed tomography angiography (CCTA) and to compare epicardial adipose tissue (EAT) thickness between BAV and tricuspid aortic valve (TAV) patients. Materials and Methods: Thirty-five BAV patients aged 42–67 and 75 TAV patients aged 31–66 were included in the study. Aortic diameters were measured at the sinus of Valsalva, sinotubular junction, and ascending and descending aorta. Agatston calcium scores and CAD–Reporting and Data System were used to assess coronary artery calcification and atherosclerosis severity. EAT thickness was measured volumetrically, and its relationship with clinical and imaging parameters was evaluated. Results: In patients with BAV, the aortic diameters at the Valsalva sinus, sinotubular junction, and ascending aorta were larger compared to patients with TAV. The difference was statistically significant ( P < 0.001). Aortic valve calcification was present in 45.7% of BAV patients, with an average Agatston score of 349.06 ± 413.22, while no calcification was detected in TAV patients. Although no significant difference in EAT thickness or CAD prevalence was observed between BAV and TAV groups, EAT thickness was positively correlated with aortic dilatation, coronary artery calcification, and aortic valve calcification. Conclusions: BAV patients exhibit distinct vascular and valvular characteristics, with aortic dilatation and aortic valve calcification being prominent. EAT may serve as a marker for these complications. Further prospective studies are needed to elucidate the pathophysiology of BAV and optimize early intervention strategies.