The aim of our study was to compare the results of the TTE (transthoracic echocardiography) with the results obtained by the ECG-gated 64 slices CT during the followup of patients with bicuspid aortic valve (BAV), after aortic valve replacement; in particular we evaluated the aortic root and the ascending aorta looking for a new algorithm in the followup of these patients. From January 1999 to December 2009 our attention was focused on 67 patients with isolated surgical substitution of aortic valve; after dismissal they were strictly observed. During the period between May and September 2010, these patients underwent their last evaluation, and clinical exams, ECG, TTE, and an ECG-gated-MDCT were performed. At followup TTE results showed an aortic root of ？mm and an ascending aorta of ？mm. ECG- gated CT showed an aortic root of ？mm and an ascending aorta of . The comparison between preoperative and postoperative TTE shows a significant long-term dilatation of the ascending aorta while the aortic root diameter seems to be stable. ECG-gated CT confirms the stability of the aortic root diameter ( ？mm versus ？ mm; <0.0001) and the increasing diameter value of the ascending aorta ( ？mm versus ？mm; ). Due to the different findings between CT and TTE studies, ECG-gated CT should no longer be considered as a complementary exam in the followup of patients with BAV, but as a fundamental role since it is a real necessity. 1. Introduction Bicuspid aortic valve is an autosomal dominant hereditary disease with incomplete penetrance and represents the most common congenital disease that can be found in the general population, with prevalence between 1% and 2%. However, a threefold higher male predominance one was observed, suggesting that this disease may be related to an X-linked hereditary [1]. This structural alteration seems to be a consequence of an abnormal developmental process of the aortic cusps during embryogenesis [2–9]. Patients with bicuspid aortic valve have a higher morbidity and mortality owing to the associated cardiovascular complications. Aortic coarctation, dilatation, and consequent aneurysm or dissections of the ascending aorta are very common in this group of patients. Aortic stenosis/insufficient valve is very common in these patients and it is related to gradual calcification of the valve. In these patients a valve replacement is necessary and the surgical rational is similar to the valve replacement of the tricuspid one. It is generally accepted that replacement of the ascending aorta should be performed, at the time of aortic valve
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