BAV Aortopathy Surveillance — EECC MCQ

Correct answer: C — Annual imaging with echocardiography (or MRI/CT if echo views are suboptimal) — BAV aortopathy requires regular surveillance even without valve disease; intervention threshold is ≥50 mm (or ≥45 mm with risk factors including family history, aortic growth >3 mm/year, or coarctation)

In bicuspid aortic valve (BAV), aortopathy can occur and progress even when there is no aortic stenosis or regurgitation, so absence of valve disease does not remove the need for aortic surveillance. An ascending aorta of 43 mm is dilated but below the usual surgical threshold; therefore the appropriate management is regular surveillance rather than discharge, 10-yearly follow-up, CT-only surveillance, or immediate surgery. In UK echo practice, BAV with aortopathy is followed with an individualised approach, with 12-month surveillance as the default. Transthoracic echocardiography is appropriate if the aortic root/ascending aorta are well seen; MRI or CT is used when echo views are inadequate or cross-sectional assessment is needed. Intervention is considered at larger diameters, typically ≥50 mm or ≥45 mm where specified high-risk features are present, such as family history, rapid growth >3 mm/year, or coarctation.

Reference: British Society of Echocardiography/British Heart Valve Society. Clinical indications and triage of echocardiography: heart valve disease (2024). https://bhvs.org/wp-content/uploads/2024/08/PUE004_Clinical-indications-triage_Heart-valve-disease.pdf