Frequency and Morphological Subtypes of Bicuspid Aortic Valve among Patients with Aortic Stenosis at a Tertiary Cardiac Center in Peshawar

Abstract

Objectives: To determine the frequency of bicuspid aortic valve (BAV) among patients with aortic stenosis (AS) and to describe its morphological fusion subtypes. Methodology: A consecutive sample of 212 adults (18–80 years) with echocardiographically confirmed AS was enrolled. Demographic characteristics, cardiovascular comorbidities, and family history were recorded. Valve morphology was assessed using transthoracic and, when required, transesophageal echocardiography, and BAV phenotypes were categorized as Type 1 (right–left), Type 2 (right–non-coronary), or Type 3 (left–non-coronary) cusp fusion. Data were analyzed using SPSS v23.0. Continuous variables were summarized as mean ± SD and categorical variables as n(%). Associations between BAV status and baseline variables were evaluated using Chi-square or Fisher’s exact tests with α = 0.05. Results: The mean age of participants was 49.77 ± 18.82 years, and the mean BMI was 26.14 ± 4.24 kg/m²; 58.0% were male. BAV was present in 75 of 212 patients (35.4%), while 137 (64.6%) had tricuspid valves. Among BAV cases, Type 1 was most frequent (48.0%), followed by Type 2 (38.7%) and Type 3 (13.3%). Hypertension, diabetes, hyperlipidemia, smoking, and family history of ischemic heart disease were reported in 52.8%, 47.2%, 40.6%, 39.6%, and 35.8% of participants, respectively. Socioeconomic and educational distributions were balanced. No demographic or clinical variable demonstrated a statistically significant association with BAV presence. Conclusion: Approximately one-third of AS patients had BAV, with right–left cusp fusion being the predominant subtype. BAV occurrence showed no significant association with demographic factors or conventional cardiovascular risk variables.