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In all patients, serial transthoracic echocardiography should be performed to evaluate the valve and disease progression.  Annual cardiac imaging is recommended for patients with significant valve lesions or with aortic root diameters >40 mm. Complete imaging of the thoracic aorta should be performed periodically for surveillance. <cite>SiuSilversides</cite>
 
In all patients, serial transthoracic echocardiography should be performed to evaluate the valve and disease progression.  Annual cardiac imaging is recommended for patients with significant valve lesions or with aortic root diameters >40 mm. Complete imaging of the thoracic aorta should be performed periodically for surveillance. <cite>SiuSilversides</cite>
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=== Treatment ===
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==== Medical treatment ====
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In patients with bicuspid aortic valve disease, high blood pressure should be aggressively. The ACC/AHA guidelines for the management of adult congenital heart disease and guidelines for the management of patients with valvular heart disease suggest that it is reasonable to use beta-blockers in this population (Class IIa recommendation). <cite>Warnes</cite> This is in accordance with the standart of care at many centers to slow the progression in Marfan-associated aortopathy.
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==== Surgery ====
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Indications for surgery are similar to that in patients with “degenerative aortic valve disease”; intervention is indicated for severe valvular dysfunction, symptomatic patients, and patients with evidence of abnormal left ventricular dimensions and function.
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In children and young adults, the bicuspid valve is not calcified and balloon valvuloplasty is recommended. A prosthetic valve implantation would be suboptimal due to the continuing growth of the child.
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Indications for valvuloplasty in children include peak-to peak gradients >50 mm Hg with ST- or T-wave changes at rest or with exercise. Valvuloplasty is also indicated for symptomatic children with peak-to-peak gradients >60 mm Hg. <cite>Warnes</cite>
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Surgical options for adult bicuspic aortic valve disease include valve replacement (bioprosthetic or mechanical valves), Ross procedure or valve repair (for those with aortic incompetence) Surgical aortic valve replacement is the most common procedure in adults with bicuspid aortic valve disease, for either aortic valve stenosis or regurgitation. Indications of interventions are similar to those described for tricuspid aortic valve disease in the ACC/AHA guidelines for the management of patients with valvular heart disease. <cite>Bonow2</cite>
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