Bicuspid aortic valve disease beyond the aortic root: potential prognostic implications for ascending aortic dilation.

Aortic root dilation is an important, potentially lethal omplication of BAV (4) that substantially increases the risk f ascending aortic aneurysm, dissection, and rupture (3). uriously, aortic valve replacement does not prevent proressive dilation of the ascending aorta (5), suggesting that echanisms unrelated to hemodynamic factors, or to the alve per se, contribute to the aortopathy of BAV. Aortic oot dilation occurs in nearly one-half of all patients with AV (6–8). However, presently there are no prognostic actors to help identify the patients who are at an increased isk of developing ascending aortic dilation. Given the strong heritability of BAV (9), genetic factors re thought to play a role in the pathogenesis of ascending ortic dilation in patients with BAV. Such a view gains upport from a recent prospective study by Biner et al. (7), ho discovered aortic root dilation in one-third of the rst-degree relatives of BAV patients who had normal ricuspid aortic valves. Those investigators also found that ndexes of aortic stiffness were higher in both BAV patients nd their first-degree relatives compared with normal conrol subjects, irrespective of the presence of aortic root ilation or hypertension status (7). Genetic factors, espeially those that regulate extracellular matrix turnover, have