Bicuspid aortic valve has often familiar clustering, consistent with autosomal dominant inheritance with incomplete penetrance. Bicuspid aortic valve is frequently associated with diseases of aortic root. According to some authors 52% percent of young people with bicuspid aortic valve have aortic dilatation regardless of significant valve dysfunction. (1)

Case: 46-years old patient with anamnesis of several years of arterial hypertension was referred to transthoracic echocardiography (TTE) as a part of screening for hypertensive heart disease. His blood pressure (at rest) was well regulated with valsartan 80mg. He was on every day heavy-weight lifting trainings for a years. That was his first echo exam in his life. Exam showed bicuspid aortic valve with ectasia of aortic root (40 mm) and marked aneurysm of ascending aorta (till 58 mm as visible by TTE). As a consequence of bicuspid valve, or aortic root dilatation (or both) he had moderate aortic regurgitation as well. Patient was told to stop heavy weight lifting immediately and make CT aortography. CT showed dilatation of aortic root and ascending aorta till 65 mm (Figures 1 and 2), while aortic arch and descending aorta were not involved (Figure 3). Patient was referred to cardiothoracic surgeon and operated.

Patient has three sons, two of them trained in heavy weight lifting as well. To all of them an transthoracic echo was done. Oldest son was 24 and was not involved in training. He had normal TTE result. Other son, 22 years old, involved in heavy weight training had bicuspid aortic valve on TTE (without significant stenosis or regurgitation) with normal diameter of aortic root/ascending aorta. He was counseled to refrain from heavy weight lifting and to make echo controls on annual basis. Third and the youngest son was 20 years old (also active in body building). TTE showed tricuspid aortic valve, although with slight irregularity of aortic valve leaflets and mild aortic regurgitation. Aortic root and ascending aorta were normal. He was told to repeat echo examination in three years.