Patients undergoing surgical repair or replacement of the aortic root or ascending aorta may be candi- dates for a valve-sparing procedure.33 39 6. LVEDD, a marker of the severity of LV volume overload in patients with chronic AR, is signifi- cantly associated with clinical outcomes in asymp- tomatic patients, and progressive increases in LVEDD are associated with subsequent need for In asymptomatic patients, it is important to ensure that apparent changes in LV size or LVEF are not due simply to measurement or physiological variability. In addition, confirmation of severe regurgitation by quantitative measures of AR severity with TTE, TEE, or, when needed, CMR provides confidence that AR is the cause of LV dila- tion or decrease in LVEF. When there is an apparent significant fall in EF or increase in LV size, repeat imaging typically is performed at 3- to 6-month intervals unless there is clinical deterioration. 7. TAVI for isolated chronic AR is challenging because of dilation of the aortic annulus and aortic root and, in many patients, lack of sufficient leaflet calcification. Risks of TAVI for treatment of AR include transcatheter valve migration and signifi- cant paravalvular leak.29 32 TAVI is rarely feasible, and then only in carefully selected patients with severe AR and HF who have a prohibitive surgi- cal risk and in whom valvular calcification and annular size are appropriate for a transcatheter approach. Figure 4. Timing of intervention for AR. Colors correspond to Table 2. AR indicates aortic regurgitation; AVR, aortic valve replacement; EDD, end-diastolic dimension; ERO, effective regurgi- tant orifice; LVEF, left ventricular ejection fraction; LVESD, left ventricular end-systolic dimension; RF, regurgitant fraction; RVol, regurgitant volume; and VC, vena contracta CLINICAL STATEMENTS AND GUIDELINES 5. BICUSPID AORTIC VALVE 5.1. BAV and Associated Aortopathy 5.1.1. Diagnosis and Follow-Up of BAV 5.1.1.1. 