# Cardiovascular CT in Bicuspid Aortic Valve Disease: A State-of-the-Art Narrative Review of Advances, Clinical Integration, and Future Directions

## TL;DR

This review discusses how cardiovascular CT is becoming essential in diagnosing and managing bicuspid aortic valve disease, with a focus on new techniques and future directions.

## Contribution

The paper provides a comprehensive and up-to-date synthesis of cardiovascular CT's role in BAV management, including new imaging techniques and future research priorities.

## Key findings

- Cardiovascular CT is essential for diagnosing BAV and planning procedures due to its high spatial resolution.
- Innovations like AI-guided analysis and supra-annular sizing are improving CT's role in BAV treatment.
- Future directions include AI predictive tools and CT-guided precision medicine for better patient outcomes.

## Abstract

Bicuspid Aortic Valve (BAV) disease is recognized as the most common congenital heart condition and is frequently associated with complex valvular and aortic disorders. Cardiovascular computed tomography (CT) has become essential for diagnosing BAV, planning procedures, and evaluating patients after treatment. This is largely due to CT’s high spatial resolution and its ability to perform volume imaging effectively. This review provides an up-to-date overview of the increasing role of cardiovascular CT in the management of bicuspid aortic valve (BAV). It covers various aspects, including BAV morphology, optimal sizing for transcatheter aortic valve replacement (TAVR), and post-procedural monitoring. We highlight significant innovations, such as supra-annular sizing techniques and artificial intelligence (AI)-guided analysis, that position CT at the nexus of anatomy, function, and targeted treatment. Additionally, we address controversies concerning inconsistencies in sizing algorithms, recent classification challenges, and radiation exposure. Future development areas include AI predictive tools, radiomic phenotyping, and CT-guided precision medicine. This synthesis aims to provide clinicians and researchers with a high-level guide to the clinical integration of cardiovascular CT and its future in the BAV population. This review provides the most current, comprehensive synthesis on the pivotal role of cardiovascular CT in BAV management, offering a roadmap for integrating advanced imaging into clinical practice and guiding future research priorities.