Understanding and treating aortopathy in bicuspid aortic valve

Bicuspid aortic valve is a simple yet common condition with surprising clinical complexity. Patients are typically found to have enlargement of the ascending aorta, either root or midascending, independent of valve function. This enlargement is perceived to be a risk of aortic dissection, and therefore, prophylactic surgery is often recommended when the aorta reaches 50–55 mm in diameter. Despite the prevalence and potential health impact, there is to date no published data on the role of medical therapy. The emerging trend, however, is to address this question through clinical research. Early trials are underway designed to address the question of potential medical therapy. This article reviews current knowledge of the condition, its potential etiology, and ongoing work to assess the role of medical therapy.