I would like to thank Miśkowiec and Kasprzak1 for their considerations of our study. The bicuspid aortic valve (BAV) morphotype right–left (RL) is related with dilation of the ascending aorta. In our series, while right–left coronary cusp fusion (BAV-RL) and right–non-coronary cusp fusion (BAV-RN) presented similar ascending aorta dilation at the tubular segment, the BAV-RN morphotype spared aortic root dilation and had significant arch enlargement compared with BAV-RL. This different phenotype of ascending aorta dilation with dilation in different segments, that is, aortic root, tubular part or aortic arch, may be explained by the eccentric flow, different jet direction, helical flow and wall shear stress of each BAV morphotype. In a recent study,2 our group proved that BAV-RL had an increase in in-plane rotational flow and axial wall shear stress at the aortic root and ascending aorta with an anterior distribution; by contrast, BAV-RN showed an increase…

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