Because pro- gression of valve disease and growth of the aorta can occur in the absence of symptoms, diagnostic imaging plays an integral role in the surveillance process. Recommendation-Specific Supportive Text 1. Aortopathy is present in approximately 20% to 40% of patients with a BAV and is associated with dilation of the aortic sinuses, the ascending aorta, and/or the arch.1 In a retrospective case series of 918 patients with BAV followed for 2 to 12 years CLINICAL STATEMENTS AND GUIDELINES with serial imaging, 47% required valve surgery but only 3.8% required aortic grafting without valve replacement, and <0.1% had aortic dissec- In a systematic review of 13 studies with >11000 patients with a BAV, aortic dilation was present in 20% to 40%, but only 0.4% suffered Aortic imaging at least annually is prudent in patients with BAV and significant aor- tic dilation (>4.5 cm) to determine the appropriate timing of surgical intervention. Patients with risk factors that increase the risk of aortic dissection, such as a rapid rate of change in aortic diameter or a family history of aortic dissection, may also require more frequent monitoring. In patients with milder dilation that shows no change on sequential studies and with a negative family his- tory, a longer interval between imaging studies is 2. In a retrospective review of 1286 patients with a BAV who underwent isolated AVR with a median of 12 years of follow-up, subsequent aortic dissection occurred in 1%, ascending aor- tic replacement surgery was needed in 0.9%, and progressive aortic enlargement was noted in In a smaller cohort of 153 patients with a BAV with prior AVR, 3% required proximal aor- tic surgery after 15 years of follow-up. 