Response to Letter Regarding Article, “Aortic Dilation in Bicuspid Aortic Valve Disease: Flow Pattern Is a Major Contributor and Differs With Valve Fusion Type”

We thank Dr Girdauskas for his interesting and pertinent questions on our recent publication1 and have responded to his queries below: 1. Unfortunately, our sample size of left-handed flow was very small (n=4), making meaningful comparison difficult. We did, however, observe that in these patients the flow jet seems to hit the aortic wall more left-anteriorly compared with the right-handed helical flow (which hits the wall more on the right side). This may be related to the significant angulation between LVOT and proximal aorta and in part to the aortic …