[Bicuspid aortic valve and associated aortopathy: from clinical examination to advanced multimodality imaging]

Bicuspid aortic valve (BAV) is the most common congenital heart disease, affecting 0.5-2% of the general population. It is often associated with aortopathy with aneurysmal dilation of the ascending aorta (AA). Up to 75% of patients with coarctation of the aorta (CoA) present with BAV and its diagnosis is crucial because it can increase the risk for aortic complications. CoA is a cardiac malformation that can be undiagnosed until old age with only hypertension as a marker of its presence.We present the case of an asymptomatic 17-year-old boy who underwent regular visit for competitive sports activity. During a treadmill test he showed a hypertensive response to effort and the echocardiogram diagnosed a normally functioning BAV associated with AA dilation. The clinical suspicion of CoA was confirmed by a complete echocardiogram, and the patient underwent catheter-based invasive aortography and the CoA was treated with angioplasty and stenting. Few years after the interventional procedure, he performed a thoracic computed tomography that showed an increased aortic dilation at the level of the Valsalva sinus and the AA. The patient underwent surgical aortic repair using the David technique. At present, the patient continues a close follow-up with advanced cardiac imaging (including cardiac magnetic resonance) for BAV surveillance and accurate detection of all aortic measures.