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Diagnosis and Management of Aortic Disease

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39 6.1.3. BAV Aortopathy COR LOE Recommendations 1 B-NR 1. In patients with a BAV, TTE is indicated to evaluate valve morpholog y and function, to evaluate the diameter of the aortic root and ascending aorta, and to evaluate for aortic coarctation and other associated cardiovascular defects. 1 C-LD 2. In patients with a BAV, CT or MRI of the thoracic aorta is indicated when the diameter and morpholog y of the aortic root, ascending aorta, or both cannot be assessed accurately or completely by TTE. 1 C-LD 3. In patients with a BAV and either HTAD or phenotypic features concerning for Loeys-Dietz syndrome, a medical genetics evaluation is recommended. 1 C-LD 4. In patients with a BAV and a dilated aortic root or ascending aorta, screening of all first-degree relatives by TTE is recommended to evaluate for the presence of a BAV, dilation of the aortic root and ascending aorta, or both; if the diameter and morpholog y of the aortic root, ascending aorta, or both cannot be assessed accurately or completely by TTE, a cardiac- gated CT or MRI of the thoracic aorta is indicated. 2a B-NR 5. In patients with a BAV, screening of all first-degree relatives by TTE is reasonable to evaluate for the presence of a BAV, dilation of the aortic root and ascending aorta, or both. 6.1.3.1. Routine Follow-Up of BAV Disease Aortopathy COR LOE Recommendations 1 B-NR 1. In patients with a BAV who have undergone previous aortic valve repair or replacement and have a diameter of the aortic root, ascending aortic, or both of ≥4.0 cm, lifelong surveillance imaging of the aortic root and ascending aorta by TTE, CT, or MRI is recommended at an interval dependent on aortic diameter and rate of growth. 1 C-LD 2. In patients with a BAV and a diameter of the aortic root, ascending aorta, or both of ≥4.0 cm, lifelong surveillance imaging of the aortic root and ascending aorta by TTE, CT, or MRI is recommended at an interval dependent on aortic diameter and rate of growth.

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