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Bicuspid Aortic Valve Aortopathy Surveillance — EECC MCQ

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EasyAortic DiseaseBicuspid Aortic Valve Aortopathy SurveillanceEECC

A 45-year-old man with a bicuspid aortic valve and mild aortic regurgitation has an ascending aortic diameter of 44 mm on echocardiography. His height is 180 cm (BSA 2.0 m²). He has no family history of aortic dissection and no coarctation. What is the recommended surveillance interval?

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Correct answer: E — Annual imaging with echocardiography and/or CT/MRI aortography

Patients with bicuspid aortic valve (BAV) and aortic dilatation (≥40 mm) should undergo annual imaging surveillance to monitor for progressive dilatation. The rate of growth determines the interval: if growth is >3 mm/year, more frequent imaging and consideration of earlier surgery may be warranted. The surgical threshold for BAV aortopathy is ≥50 mm (or ≥45 mm with risk factors such as family history of dissection, coarctation, rapid growth >3 mm/year, or severe AR). At 44 mm, this patient is below the surgical threshold but requires regular monitoring. Cross-sectional imaging (CT or MRI) provides more reproducible measurements than echo for serial surveillance of the ascending aorta.

Reference: ESC/EACTS (2025): Guidelines for the Management of Valvular Heart Disease; ESC (2024): Aortic Disease Guidelines