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©2013 UpToDate ® Print Email ACC/AHA guideline summary: Evaluation of a biscuspid aortic valve for a dilated ascending aorta Class I - There is evidence and/or generalagreement that the following tests should be performed in patients witha bicuspid aortic valve •  Initial transthoracic echocardiogram to determine the diameter of the aortic root (sinuses of Valsalva and sinotubular junction) and ascending aorta. •  Cardiac MRI or CT when the morphology of the aortic root and ascending aorta cannot be accurately assessed by echocardiography. •  Among patients with dilatation of the aortic root or ascending aorta (diameter >40 mm), yearly echocardiography or cardiac MRI or CT. Class IIa - The weight of evidence oropinion is in favor of the usefulness of the following test inpatients with a bicuspid aortic valve •  Cardiac MRI or CT when aortic root dilatation is detected by echocardiography to further assess the severity of aortic root dilatation as well as possible involvement of the ascending aorta. Data from Bonow RO, Carabello BA, Chatterjee K, et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing committee to revise the 1998 guidelines for the management of patients with valvular heart disease). J Am Coll Cardiol 2006; 48:e1.