Open Access

REVIEW

Bicuspid Aortic Valve Disease, the Dilated Proximal Aorta, and the Surgical Treatment Options: A Narrative Review

Wilhelm Mistiaen^*

Department of Rehabilitation Sciences, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, 2610, Belgium

* Corresponding Author: Wilhelm Mistiaen. Email:

Congenital Heart Disease 2025, 20(3), 305-323. https://doi.org/10.32604/chd.2025.064675

Received 21 February 2025; Accepted 20 June 2025; Issue published 11 July 2025

Abstract

The presence of a bicuspid aortic valve (BAV) is the most common congenital heart anomaly, which can remain asymptomatic for decades, if it is not a part of a syndrome, such as Turner syndrome or genetic connective tissue disorders. There are several classifications for BAV, each with its advantages and drawbacks. The condition can lead to valvular malfunction such as regurgitation and stenosis, but is often associated with dilatation of the aortic root, the ascending aorta, the aortic arch, or a combination. Altered flow patterns due to the valve dysfunction as well as the breakdown of elastin in the aortic wall could be responsible for this development. Published surgical series are usually small and research designs vary, which makes the formulation of universal recommendations for treatment difficult. This narrative review provides data from the most recent series in this respect. Often, the condition becomes symptomatic in patients who are about 10 years younger compared to those with a diseased tricuspid aortic valve. The timing of surgery of the valve depends on the degree of its dysfunction. Repair of a dysfunctional BAV should be attempted whenever possible because of the patient’s age. The options for valve repair are summarized, including the need for the use as the effective geometric height. The use of a pericardial patch and the presence of calcified areas of the valve can be predictors for an increased need for reintervention. In those cases, a valve replacement should be preferred. If a dilatation of the ascending aorta or the aortic root is present, this should also be addressed surgically, but the threshold for such a procedure varies. Several techniques are available to treat a dilated ascending aorta and root. For the latter, remodeling and reimplantation can be applied. Depending on the patient’s characteristics, the size of the dilatation, and the affected part, the most appropriate technique should be selected. This requires surgical expertise, which can only be obtained in high-volume centers.

---

Keywords

---