A measured approach to managing the aortic root in patients with bicuspid aortic valve disease

Bicuspid (or bicommissural) aortic valve (BAV) is the most common cardiovascular malformation in humans, with a prevalence of 1% to 2% in the general population and a 2:1 male:female ratio. BAV is frequently associated with other cardiovascular malformations, including aortic root dilatation, which affects about 40% of individuals with BAVs and is thought to be associated with increased risk of dissection and/or rupture. Currently, no agreement exists about the optimal management of these patients. We review the pathophysiology and possible determinants of aortic disease associated with BAV, the natural history of aortic wall size progression, and suggest management strategies to prevent acute aortic events.