Light on the molecular and cellular mechanisms of bicuspid aortic valve to unveil phenotypic heterogeneity

Research on bicuspid aortic valve disease (BAV) and related com- plications has grown in an exponential manner in the last decades. However, the current knowledge of the mechanisms underlying the development of this disease is still limited, since all clinical and surgical studies on BAV mainly focused their objects on its major vascular complications, such as ascending aortic aneurysms and dissection. It is now clear that a better understanding of the pivotal molecular and cellular pathophysiological aspects of bicuspid valve aortopathy, in- cluding natural history, phenotypic expression, histology, cellular me- chanisms and pathways, is critical for improving its clinical manage- ment. This changing paradigm has clearly emerged in the recently released American Association for Thoracic Surgery (AATS) consensus guidelines focusing on bicuspid aortic valve-related aortopathy, which covered all major aspects of BAV].