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Brain & Heart

REVIEW ARTICLE
Contemporary clinical perspectives, multi-

modality imaging, and management strategies
for bicuspid aortic valves

Faysal Massad 1 , Ahmad Safdar 1 , Elio Haroun 1 , Aro Daniela Arockiam 1 ,
Mahmoud Alshneikat 2 , Akiva Rosenzveig 1 , Simrat Kaur 1 , and
1
Tom Kai Ming Wang *
1 Department of Cardiovascular Medicine, Heart, Vascular Section of Cardiovascular Imaging, and
Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
2 Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute,
Cleveland Clinic, Cleveland, Ohio, United States of America

Abstract

Bicuspid aortic valve (BAV) is a common congenital cardiac anomaly, characterized
by the presence of two functional aortic valve leaflets instead of the usual three. It
affects approximately 1 – 2% of the population and is often associated with other
cardiovascular complications, including aortic stenosis, aortic regurgitation, and
aortic root dilation. BAV can present with a wide range of clinical manifestations,
from asymptomatic individuals to those with severe aortic valve dysfunction or aortic
dissection. The diagnosis of BAV is commonly established through non-invasive
*Corresponding author:
Tom Kai Ming Wang imaging techniques such as transthoracic and transesophageal echocardiography,
(wangt2@ccf.org) with advanced modalities, such as computed tomography and magnetic
Citation: Massad F, Safdar A, resonance imaging providing superior delineation of valve morphology, aortic root
Haroun E, et al. Contemporary measurements, and associated pathology. Management of BAV is multifaceted and
clinical perspectives, multi-modality depends on the severity of valvular and aortic involvement. Lifelong surveillance
imaging, and management
strategies for bicuspid is often necessary, with serial imaging to monitor disease progression. Surgical
aortic valves. Brain & Heart. intervention is indicated for patients with severe valve dysfunction, symptomatic
2025;3(3):025050008. disease, or aortic aneurysm exceeding established threshold diameters. Common
doi: 10.36922/BH025050008 procedures include aortic valve replacement (AVR) and composite graft repair, such as
Received: February 1, 2025 the Bentall or valve-sparing David procedure. Transcatheter AVR has also emerged as
Revised: April 14, 2025 a less invasive alternative to surgical valve replacement within this patient population,
with its indications expanding significantly in recent years due to growing interest and
Accepted: April 23, 2025 advancements in the field. Despite substantial progress in diagnostic and therapeutic
Published online: May 8, 2025 strategies, BAV poses clinical challenges due to its heterogeneous presentation,
Copyright: © 2025 Author(s). genetic underpinnings, and the requirement for tailored management approaches.
This is an Open-Access article
distributed under the terms of the
Creative Commons Attribution Keywords: Bicuspid aortic valve; Aortic valve; Aortic stenosis; Aortic regurgitation; Aortic
License, permitting distribution, aneurysm
and reproduction in any medium,
provided the original work is
properly cited.
Publisher’s Note: AccScience
Publishing remains neutral with 1. Introduction
regard to jurisdictional claims in
published maps and institutional Bicuspid aortic valve (BAV) is a common congenital heart defect. BAV was first described
affiliations. by Leonardo Da Vinci while he was exploring cardiovascular anatomy more than 500 years

Volume 3 Issue 3 (2025) 1 doi: 10.36922/BH025050008