Bicuspid aortic valve is the most frequently seen congenital
heart anomaly. It is not only a valvular disease but also an
aortic disease characterized with a defect especially in the
the media layer of the ascending aorta. When compared
with the ascending aorta of the patients with tricuspid
valve, ascending aortic dilatation is more common and
faster and this can cause dissection or rupture at an earlier
age. For these reasons, ascending aortic replacement is
recommended if the aortic diameter is greater than 5 cm,
or if it is greater than 4.5 cm with some coexisting risk
factors, or if it is greater than 4 cm in patients requiring
valve replacement. However, these recommendations are
based on limited evidence. Prospective controlled trials
are required to obtain evidence-based recommendations.