AORTIC DILATATION AS A CLUE TO BICUSPID AORTIC VALVE FROM DIAGNOSIS TO TIMELY SURGERY A CASE REPORT AND LITERATURE REVIEW

Background: Bicuspid aortic valve (BAV) may be associated with progressive aortic enlargement despite preserved valve function. Selecting the appropriate time for prophylactic intervention requires aortic phenotyping and individualized risk assessment. Case presentation: A 56-year-old man without significant medical history or cardiovascular risk factors was evaluated before surgery for lumbar disc herniation with motor-deficit sciatica. He was asymptomatic from a cardiac standpoint; examination revealed no aortic murmur, blood pressure was 120/70 mmHg, and ECG showed sinus rhythm at 75 beats/min without left ventricular hypertrophy. Chest radiography suggested proximal aortic enlargement. Echocardiography revealed type 0 BAV with morphologically altered cusps but neither stenosis nor regurgitation, and an aortic diameter of 42 mm at both the sinuses of Valsalva and sinotubular junction. Cardiac chambers were normal, and laboratory assessment was unremarkable. Discussion: BAV-related aortopathy requires evaluation independently of valve dysfunction. Current US and European guidance generally supports imaging surveillance at 42 mm rather than prophylactic surgery, in the absence of additional high-risk findings. Conclusion: Comprehensive aortic imaging, familial assessment, and lifelong surveillance are central to management of incidentally identified BAV aortopathy.