. Author manuscript; available in PMC: 2019 Feb 21.

Published in final edited form as: J Thorac Cardiovasc Surg. 2018 Aug;156(2):473–480. doi: 10.1016/j.jtcvs.2017.10.161

TABLE 4.

Recommendations for postsurgical repair, medical management, and watchful waiting

Recommendation	Class/LOE
Radiologic imaging (with CTA or MRA) may be performed after aortic surgery to establish a postrepair baseline.	IIb/C
Ongoing postoperative surveillance intervals should be individualized on the basis of the clinical, anatomic, and surgical features. In the presence of residual aortic dilation/pathology, it is reasonable to image the entire aorta every 3–5 y by CT or MRI after repair.	IIa/B^{6,13,15–17,21}
MRI should be considered for repeat examinations in an adolescent or in the adult population aged <50 y.	IIa/B¹⁸
Treatment of hypertension is recommended according to country-and region-specific guidelines.	I/C^13,53–57
Beta-blockers and inhibitors of the reninangiotensin system should be considered for blood pressure control based on evidence extrapolated from connective tissue disease populations. Nonpharmacologic approaches (salt reduction, weight reduction) should be advocated as part of blood pressure control strategies.	IIa/C^13,53–55
Patients with aortic aneurysms that are at or near surgical thresholds for correction should avoid strenuous lifting, pushing, or straining that would require a Valsalva maneuver.	IIa/C^{3,36,48,49,58}
It is recommended to avoid heavy weight lifting or competitive athletics involving isometric exercise when the ascending aortic diameter is >45 mm.	I/B^{3,36,48,49,58}
Patients with BAVand dilated aorta should be precluded from private driving if the ascending aorta diameter is >6.0 and restricted from commercial driving if the ascending thoracic aorta diameter is >5.5 cm.	IIa/C^36,47
It is recommended that prepregnancy evaluation and postpregnancy management of women with BAV with or without associated aortopathy be performed by practitioners with expertise in the management of pregnant women with heart disease.	I/C⁵⁹
First-degree relatives of patients with BAV should undergo screening echocardiography.	IIa/B⁵²

LOE, Level of evidence; CTA, computed tomography angiography; MRA, magnetic resonance angiography; CT, computed tomography; MRI, magnetic resonance imaging; BAV, bicuspid aortic valve.