Bicuspid Aortic Valve-Related Aortopathy

TTE is the initial imaging modality of choice for assessment of the aortic valve and thoracic aorta in patients with BAV.

The entire thoracic aorta should be measured by TTE, reporting each aortic segment separately in millimeters: root (sinuses of Valsalva), STJ, tubular ascending aorta (proximal, mid, and distal), arch, and descending thoracic aorta. Maximum diameter, regardless of location, should be reported. Aortic coarctation should be ruled out with Doppler evaluation of the descending thoracic aorta and abdominal aorta.

If TTE cannot visualize any aortic segment, any segment measures 45 mm, or aortic coarctation cannot be ruled out, recommend assessment of the entire thoracic aorta with ECG-gated cardiac MRA or CTA.

If a patient is undergoing cardiac surgery and root or tubular ascending aorta measure 40-44 mm by TTE, recommend assessment of the thoracic aorta with MRA or CTA before surgery.

If aortic coarctation is present, screening for cerebral aneurysms is recommended.